KIDS Distribution saved on Jun 13, 2022@07:58:49 BPS PSO PSX BUNDLE 20.0, BPS*1.0*32, PSO*7.0*648, PSX*2.0*93 **KIDS**:BPS PSO PSX BUNDLE 20.0^BPS*1.0*32^PSO*7.0*648^PSX*2.0*93^ **INSTALL NAME** BPS PSO PSX BUNDLE 20.0 "BLD",12512,0) BPS PSO PSX BUNDLE 20.0^^1^3220613^y "BLD",12512,6) 10 "BLD",12512,6.3) 12 "BLD",12512,10,0) ^9.63^3^3 "BLD",12512,10,1,0) BPS*1.0*32^1 "BLD",12512,10,2,0) PSO*7.0*648^1 "BLD",12512,10,3,0) PSX*2.0*93^1 "BLD",12512,10,"B","BPS*1.0*32",1) "BLD",12512,10,"B","PSO*7.0*648",2) "BLD",12512,10,"B","PSX*2.0*93",3) "BLD",12512,"KRN",0) ^9.67PA^1.5^25 "BLD",12512,"KRN",.4,0) .4 "BLD",12512,"KRN",.401,0) .401 "BLD",12512,"KRN",.402,0) .402 "BLD",12512,"KRN",.403,0) .403 "BLD",12512,"KRN",.5,0) .5 "BLD",12512,"KRN",.84,0) .84 "BLD",12512,"KRN",1.5,0) 1.5 "BLD",12512,"KRN",1.6,0) 1.6 "BLD",12512,"KRN",1.61,0) 1.61 "BLD",12512,"KRN",1.62,0) 1.62 "BLD",12512,"KRN",3.6,0) 3.6 "BLD",12512,"KRN",3.8,0) 3.8 "BLD",12512,"KRN",9.2,0) 9.2 "BLD",12512,"KRN",9.8,0) 9.8 "BLD",12512,"KRN",19,0) 19 "BLD",12512,"KRN",19.1,0) 19.1 "BLD",12512,"KRN",101,0) 101 "BLD",12512,"KRN",409.61,0) 409.61 "BLD",12512,"KRN",771,0) 771 "BLD",12512,"KRN",779.2,0) 779.2 "BLD",12512,"KRN",870,0) 870 "BLD",12512,"KRN",8989.51,0) 8989.51 "BLD",12512,"KRN",8989.52,0) 8989.52 "BLD",12512,"KRN",8993,0) 8993 "BLD",12512,"KRN",8994,0) 8994 "BLD",12512,"KRN","B",.4,.4) "BLD",12512,"KRN","B",.401,.401) "BLD",12512,"KRN","B",.402,.402) "BLD",12512,"KRN","B",.403,.403) "BLD",12512,"KRN","B",.5,.5) "BLD",12512,"KRN","B",.84,.84) "BLD",12512,"KRN","B",1.5,1.5) "BLD",12512,"KRN","B",1.6,1.6) "BLD",12512,"KRN","B",1.61,1.61) "BLD",12512,"KRN","B",1.62,1.62) "BLD",12512,"KRN","B",3.6,3.6) "BLD",12512,"KRN","B",3.8,3.8) "BLD",12512,"KRN","B",9.2,9.2) "BLD",12512,"KRN","B",9.8,9.8) "BLD",12512,"KRN","B",19,19) "BLD",12512,"KRN","B",19.1,19.1) "BLD",12512,"KRN","B",101,101) "BLD",12512,"KRN","B",409.61,409.61) "BLD",12512,"KRN","B",771,771) "BLD",12512,"KRN","B",779.2,779.2) "BLD",12512,"KRN","B",870,870) "BLD",12512,"KRN","B",8989.51,8989.51) "BLD",12512,"KRN","B",8989.52,8989.52) "BLD",12512,"KRN","B",8993,8993) "BLD",12512,"KRN","B",8994,8994) "MBREQ") 0 "QUES","XPF1",0) Y "QUES","XPF1","??") ^D REP^XPDH "QUES","XPF1","A") Shall I write over your |FLAG| File "QUES","XPF1","B") YES "QUES","XPF1","M") D XPF1^XPDIQ "QUES","XPF2",0) Y "QUES","XPF2","??") ^D DTA^XPDH "QUES","XPF2","A") Want my data |FLAG| yours "QUES","XPF2","B") YES "QUES","XPF2","M") D XPF2^XPDIQ "QUES","XPI1",0) YO "QUES","XPI1","??") ^D INHIBIT^XPDH "QUES","XPI1","A") Want KIDS to INHIBIT LOGONs during the install "QUES","XPI1","B") NO "QUES","XPI1","M") D XPI1^XPDIQ "QUES","XPM1",0) PO^VA(200,:EM "QUES","XPM1","??") ^D MG^XPDH "QUES","XPM1","A") Enter the Coordinator for Mail Group '|FLAG|' "QUES","XPM1","B") "QUES","XPM1","M") D XPM1^XPDIQ "QUES","XPO1",0) Y "QUES","XPO1","??") ^D MENU^XPDH "QUES","XPO1","A") Want KIDS to Rebuild Menu Trees Upon Completion of Install "QUES","XPO1","B") NO "QUES","XPO1","M") D XPO1^XPDIQ "QUES","XPZ1",0) Y "QUES","XPZ1","??") ^D OPT^XPDH "QUES","XPZ1","A") Want to DISABLE Scheduled Options, Menu Options, and Protocols "QUES","XPZ1","B") NO "QUES","XPZ1","M") D XPZ1^XPDIQ "QUES","XPZ2",0) Y "QUES","XPZ2","??") ^D RTN^XPDH "QUES","XPZ2","A") Want to MOVE routines to other CPUs "QUES","XPZ2","B") NO "QUES","XPZ2","M") D XPZ2^XPDIQ "VER") 8.0^22.2 **INSTALL NAME** BPS*1.0*32 "BLD",12483,0) BPS*1.0*32^E CLAIMS MGMT ENGINE^0^3220613^y "BLD",12483,4,0) ^9.64PA^9002313.91^2 "BLD",12483,4,9002313.02,0) 9002313.02 "BLD",12483,4,9002313.02,222) y^y^f^^^^n "BLD",12483,4,9002313.91,0) 9002313.91 "BLD",12483,4,9002313.91,222) y^y^f^^n^^y^o^n "BLD",12483,4,"B",9002313.02,9002313.02) "BLD",12483,4,"B",9002313.91,9002313.91) "BLD",12483,6) 4 "BLD",12483,6.3) 15 "BLD",12483,"ABPKG") n "BLD",12483,"KRN",0) ^9.67PA^1.5^25 "BLD",12483,"KRN",.4,0) .4 "BLD",12483,"KRN",.4,"NM",0) ^9.68A^^ "BLD",12483,"KRN",.401,0) .401 "BLD",12483,"KRN",.401,"NM",0) ^9.68A^^ "BLD",12483,"KRN",.402,0) .402 "BLD",12483,"KRN",.403,0) .403 "BLD",12483,"KRN",.5,0) .5 "BLD",12483,"KRN",.84,0) .84 "BLD",12483,"KRN",1.5,0) 1.5 "BLD",12483,"KRN",1.6,0) 1.6 "BLD",12483,"KRN",1.61,0) 1.61 "BLD",12483,"KRN",1.62,0) 1.62 "BLD",12483,"KRN",3.6,0) 3.6 "BLD",12483,"KRN",3.8,0) 3.8 "BLD",12483,"KRN",9.2,0) 9.2 "BLD",12483,"KRN",9.8,0) 9.8 "BLD",12483,"KRN",9.8,"NM",0) ^9.68A^3^3 "BLD",12483,"KRN",9.8,"NM",1,0) BPSOSCC^^0^B30984593 "BLD",12483,"KRN",9.8,"NM",2,0) BPSRES^^0^B220162120 "BLD",12483,"KRN",9.8,"NM",3,0) BPSRES1^^0^B58424705 "BLD",12483,"KRN",9.8,"NM","B","BPSOSCC",1) "BLD",12483,"KRN",9.8,"NM","B","BPSRES",2) "BLD",12483,"KRN",9.8,"NM","B","BPSRES1",3) "BLD",12483,"KRN",19,0) 19 "BLD",12483,"KRN",19.1,0) 19.1 "BLD",12483,"KRN",101,0) 101 "BLD",12483,"KRN",409.61,0) 409.61 "BLD",12483,"KRN",771,0) 771 "BLD",12483,"KRN",779.2,0) 779.2 "BLD",12483,"KRN",870,0) 870 "BLD",12483,"KRN",8989.51,0) 8989.51 "BLD",12483,"KRN",8989.52,0) 8989.52 "BLD",12483,"KRN",8993,0) 8993 "BLD",12483,"KRN",8994,0) 8994 "BLD",12483,"KRN","B",.4,.4) "BLD",12483,"KRN","B",.401,.401) "BLD",12483,"KRN","B",.402,.402) "BLD",12483,"KRN","B",.403,.403) "BLD",12483,"KRN","B",.5,.5) "BLD",12483,"KRN","B",.84,.84) "BLD",12483,"KRN","B",1.5,1.5) "BLD",12483,"KRN","B",1.6,1.6) "BLD",12483,"KRN","B",1.61,1.61) "BLD",12483,"KRN","B",1.62,1.62) "BLD",12483,"KRN","B",3.6,3.6) "BLD",12483,"KRN","B",3.8,3.8) "BLD",12483,"KRN","B",9.2,9.2) "BLD",12483,"KRN","B",9.8,9.8) "BLD",12483,"KRN","B",19,19) "BLD",12483,"KRN","B",19.1,19.1) "BLD",12483,"KRN","B",101,101) "BLD",12483,"KRN","B",409.61,409.61) "BLD",12483,"KRN","B",771,771) "BLD",12483,"KRN","B",779.2,779.2) "BLD",12483,"KRN","B",870,870) "BLD",12483,"KRN","B",8989.51,8989.51) "BLD",12483,"KRN","B",8989.52,8989.52) "BLD",12483,"KRN","B",8993,8993) "BLD",12483,"KRN","B",8994,8994) "BLD",12483,"QUES",0) ^9.62^^ "BLD",12483,"REQB",0) ^9.611^2^2 "BLD",12483,"REQB",1,0) BPS*1.0*27^2 "BLD",12483,"REQB",2,0) BPS*1.0*30^2 "BLD",12483,"REQB","B","BPS*1.0*27",1) "BLD",12483,"REQB","B","BPS*1.0*30",2) "DATA",9002313.91,1,0) 101^^IIN NUMBER^N^^^^6^N "DATA",9002313.91,1,5) A1^6^^1 "DATA",9002313.91,1,10,0) ^9002313.9101^1^1^3191009^ "DATA",9002313.91,1,10,1,0) S BPS("X")=$G(BPS("NCPDP","BIN Number")) "DATA",9002313.91,1,20,0) ^9002313.9102^1^1^3191009^ "DATA",9002313.91,1,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6) "DATA",9002313.91,1,25,0) ^9002313.9104^1^1^3191009^^^^ "DATA",9002313.91,1,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6) "DATA",9002313.91,1,30,0) ^9002313.9103^1^1^3191009^^^^ "DATA",9002313.91,1,30,1,0) S $P(^BPSC(BPS(9002313.02),100),U,1)=BPS("X") "DATA",9002313.91,2,0) 102^^VERSION/RELEASE NUMBER^A/N^^^^2^A/N "DATA",9002313.91,2,5) A2^2^^1^22 "DATA",9002313.91,2,10,0) ^9002313.9101^1^1^3061023 "DATA",9002313.91,2,10,1,0) S BPS("X")=$G(BPS("NCPDP","Version")) "DATA",9002313.91,2,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,2,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,2,25,0) ^9002313.9104^1^1^3040114^^^^ "DATA",9002313.91,2,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,2,30,0) ^9002313.9103^1^1^3040114^^^^ "DATA",9002313.91,2,30,1,0) S $P(^BPSC(BPS(9002313.02),100),U,2)=BPS("X") "DATA",9002313.91,3,0) 103^^TRANSACTION CODE^N^^^^2^A/N "DATA",9002313.91,3,5) A3^2^^1^22 "DATA",9002313.91,3,10,0) ^9002313.9101^1^1^3061023 "DATA",9002313.91,3,10,1,0) S BPS("X")=$G(BPS("Transaction Code")) "DATA",9002313.91,3,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,3,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,3,25,0) ^9002313.9104^1^1^3040130^^^^ "DATA",9002313.91,3,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,3,30,0) ^9002313.9103^1^1^3040130^^^^ "DATA",9002313.91,3,30,1,0) S $P(^BPSC(BPS(9002313.02),100),U,3)=BPS("X") "DATA",9002313.91,4,0) 104^^PROCESSOR CONTROL NUMBER^A/N^^^^10^A/N "DATA",9002313.91,4,5) A4^10^^1 "DATA",9002313.91,4,10,0) ^9002313.9101^1^1^3061023 "DATA",9002313.91,4,10,1,0) S BPS("X")=$G(BPS("NCPDP","PCN")) "DATA",9002313.91,4,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,4,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,4,25,0) ^9002313.9104^1^1^3040820^^^^ "DATA",9002313.91,4,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,4,30,0) ^9002313.9103^1^1^3040820^^^^ "DATA",9002313.91,4,30,1,0) S $P(^BPSC(BPS(9002313.02),100),U,4)=BPS("X") "DATA",9002313.91,5,0) 201^^SERVICE PROVIDER ID^A/N^^^^15^A/N "DATA",9002313.91,5,5) B1^12^^1^22 "DATA",9002313.91,5,10,0) ^^1^1^3110523^ "DATA",9002313.91,5,10,1,0) S BPS("X")=$G(BPS("Site","NPI")) "DATA",9002313.91,5,20,0) ^9002313.9102^1^1^3110523^ "DATA",9002313.91,5,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,5,25,0) ^^1^1^3110523^ "DATA",9002313.91,5,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,5,30,0) ^^1^1^3110523^ "DATA",9002313.91,5,30,1,0) S $P(^BPSC(BPS(9002313.02),200),U,1)=BPS("X") "DATA",9002313.91,6,0) 301^^GROUP ID^A/N^^^^15^A/N "DATA",9002313.91,6,5) C1^15^^3^24 "DATA",9002313.91,6,10,0) ^9002313.9101^1^1^3101216^ "DATA",9002313.91,6,10,1,0) S BPS("X")=$G(BPS("Insurer","Group #")) "DATA",9002313.91,6,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,6,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,6,25,0) ^9002313.9104^1^1^3041021^^^^ "DATA",9002313.91,6,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,6,30,0) ^9002313.9103^1^1^3041021^^^^ "DATA",9002313.91,6,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,1)=BPS("X") "DATA",9002313.91,7,0) 302^^CARDHOLDER ID^A/N^^^^20^A/N "DATA",9002313.91,7,5) C2^20^^3^24 "DATA",9002313.91,7,10,0) ^9002313.9101^1^1^3041021 "DATA",9002313.91,7,10,1,0) S BPS("X")=$G(BPS("Insurer","Policy #")) "DATA",9002313.91,7,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,7,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,7,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,7,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,7,30,0) ^9002313.9103^1^1^3101004^^^ "DATA",9002313.91,7,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,2)=$TR(BPS("X")," ","") "DATA",9002313.91,8,0) 303^^PERSON CODE^A/N^^^^3^A/N "DATA",9002313.91,8,5) C3^3^^3 "DATA",9002313.91,8,10,0) ^9002313.9101^1^1^3040114 "DATA",9002313.91,8,10,1,0) S BPS("X")=$G(BPS("Insurer","Person Code")) "DATA",9002313.91,8,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,8,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,8,25,0) ^9002313.9104^1^1^3040114^^^^ "DATA",9002313.91,8,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,8,30,0) ^9002313.9103^1^1^3040114^^^^ "DATA",9002313.91,8,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,3)=BPS("X") "DATA",9002313.91,9,0) 304^^DATE OF BIRTH^N^^^^8^N "DATA",9002313.91,9,5) C4^8^^2^25 "DATA",9002313.91,9,10,0) ^9002313.9101^1^1^3040820 "DATA",9002313.91,9,10,1,0) S BPS("X")=$G(BPS("Patient","DOB")) "DATA",9002313.91,9,20,0) ^9002313.9102^1^1^3101029^ "DATA",9002313.91,9,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,9,25,0) ^9002313.9104^1^1^3040820^^^^ "DATA",9002313.91,9,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,9,30,0) ^9002313.9103^1^1^3101004^ "DATA",9002313.91,9,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,4)=$G(BPS("X")) "DATA",9002313.91,10,0) 305^^PATIENT GENDER CODE^N^^^^1^N "DATA",9002313.91,10,5) C5^1^^2 "DATA",9002313.91,10,10,0) ^9002313.9101^1^1^3220602^^ "DATA",9002313.91,10,10,1,0) S BPS("X")=$G(BPS("Patient","Gender Code")) "DATA",9002313.91,10,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,10,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,10,25,0) ^9002313.9104^1^1^3040114^^ "DATA",9002313.91,10,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,10,30,0) ^9002313.9103^1^1^3040114^^^^ "DATA",9002313.91,10,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,5)=BPS("X") "DATA",9002313.91,11,0) 306^^PATIENT RELATIONSHIP CODE^N^^^^1^N "DATA",9002313.91,11,5) C6^1^^3 "DATA",9002313.91,11,10,0) ^9002313.9101^1^1^3040114 "DATA",9002313.91,11,10,1,0) S BPS("X")=$G(BPS("Insurer","Relationship")) "DATA",9002313.91,11,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,11,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,11,25,0) ^9002313.9104^1^1^3040114^^^ "DATA",9002313.91,11,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,11,30,0) ^9002313.9103^1^1^3040114^^^^ "DATA",9002313.91,11,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,6)=BPS("X") "DATA",9002313.91,12,0) 308^^OTHER COVERAGE CODE^N^^^^2^N "DATA",9002313.91,12,5) C8^2^^4 "DATA",9002313.91,12,10,0) ^9002313.9101^2^2^3101115^ "DATA",9002313.91,12,10,1,0) S BPS("X")=$G(BPS("Patient","Other Coverage Code")) "DATA",9002313.91,12,10,2,0) S:'BPS("X") BPS("X")=0 "DATA",9002313.91,12,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,12,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,12,25,0) ^9002313.9104^1^1^3040114^^^^ "DATA",9002313.91,12,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,12,30,0) ^9002313.9103^1^1^3101115^^^ "DATA",9002313.91,12,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),300),U,8)=BPS("X") "DATA",9002313.91,13,0) 401^^DATE OF SERVICE^N^^^^8^N "DATA",9002313.91,13,5) D1^8^^1^22 "DATA",9002313.91,13,10,0) ^^1^1^3121128 "DATA",9002313.91,13,10,1,0) S BPS("X")=$G(BPS("NCPDP","DOS")) "DATA",9002313.91,13,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,13,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,13,25,0) ^9002313.9104^1^1^3040113^^^^ "DATA",9002313.91,13,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,13,30,0) ^^1^1^3121128 "DATA",9002313.91,13,30,1,0) S $P(^BPSC(BPS(9002313.02),401),U,1)=BPS("X") "DATA",9002313.91,14,0) 307^^PLACE OF SERVICE^A/N^^^^2^N "DATA",9002313.91,14,5) C7^2^^2 "DATA",9002313.91,14,10,0) ^9002313.9101^1^1^3040820 "DATA",9002313.91,14,10,1,0) S BPS("X")=$G(BPS("Patient","Place of Service")) "DATA",9002313.91,14,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,14,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,14,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,14,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,14,30,0) ^9002313.9103^1^1^3100910^^^^ "DATA",9002313.91,14,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,7)=BPS("X") "DATA",9002313.91,15,0) 309^^ELIGIBILITY CLARIFICATION CODE^N^^^^1^N "DATA",9002313.91,15,5) C9^1^^3 "DATA",9002313.91,15,10,0) ^^2^2^3110727^ "DATA",9002313.91,15,10,1,0) S BPS("X")=$G(BPS("Insurer","Eligibility Clarification Code")) "DATA",9002313.91,15,10,2,0) S:BPS("X")="" BPS("X")=0 "DATA",9002313.91,15,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,15,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,15,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,15,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,15,30,0) ^9002313.9103^1^1^3040114^^^^ "DATA",9002313.91,15,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,9)=BPS("X") "DATA",9002313.91,16,0) 310^^PATIENT FIRST NAME^A/N^^^^12^A/N "DATA",9002313.91,16,5) CA^12^^2^25 "DATA",9002313.91,16,10,0) ^^1^1^3101216^ "DATA",9002313.91,16,10,1,0) S BPS("X")=$G(BPS("Patient","First Name")) "DATA",9002313.91,16,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,16,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12) "DATA",9002313.91,16,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,16,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12) "DATA",9002313.91,16,30,0) ^9002313.9103^1^1^3101004^^^^ "DATA",9002313.91,16,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,10)=BPS("X") "DATA",9002313.91,17,0) 311^^PATIENT LAST NAME^A/N^^^^15^A/N "DATA",9002313.91,17,5) CB^15^^2^25 "DATA",9002313.91,17,10,0) ^^1^1^3101216^ "DATA",9002313.91,17,10,1,0) S BPS("X")=$G(BPS("Patient","Last Name")) "DATA",9002313.91,17,20,0) ^9002313.9102^1^1^3101004^ "DATA",9002313.91,17,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,17,25,0) ^9002313.9104^1^1^3101004^^^ "DATA",9002313.91,17,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,17,30,0) ^9002313.9103^1^1^3101004^^^ "DATA",9002313.91,17,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,11)=$G(BPS("X")) "DATA",9002313.91,18,0) 402^^PRESCRIPTION/SERVICE REF NO^N^^^^12^N "DATA",9002313.91,18,1) PRESCRIPTION/SERVICE REFERENCE NUMBER "DATA",9002313.91,18,5) D2^7^^4^27 "DATA",9002313.91,18,10,0) ^9002313.9101^1^1^3171117^^^^ "DATA",9002313.91,18,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"RX IEN")) "DATA",9002313.91,18,20,0) ^9002313.9102^2^2^3171117^^ "DATA",9002313.91,18,20,1,0) I $L($G(BPS("X")))>12 S BPS("X")=$E(BPS("X"),$L(BPS("X"))-11,$L(BPS("X"))) "DATA",9002313.91,18,20,2,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),12) "DATA",9002313.91,18,25,0) ^9002313.9104^2^2^3171117^^^^ "DATA",9002313.91,18,25,1,0) I $L(BPS("X"))>7 S BPS("X")=$E(BPS("X"),$L(BPS("X"))-6,$L(BPS("X"))) "DATA",9002313.91,18,25,2,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),7) "DATA",9002313.91,18,30,0) ^9002313.9103^1^1^3171117^^^^ "DATA",9002313.91,18,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,2)=BPS("X") "DATA",9002313.91,19,0) 403^^FILL NUMBER^N^^^^2^N "DATA",9002313.91,19,5) D3^2^^4 "DATA",9002313.91,19,10,0) ^9002313.9101^1^1^3030718 "DATA",9002313.91,19,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Refill #")) "DATA",9002313.91,19,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,19,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,19,25,0) ^9002313.9104^1^1^3030718^^ "DATA",9002313.91,19,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,19,30,0) 1^9002313.9103^1^1^3030718^^^ "DATA",9002313.91,19,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,3)=BPS("X") "DATA",9002313.91,20,0) B87^^QUAN LIMIT PER SPC TM PD COUNT^^^^^1^N "DATA",9002313.91,20,1) QUANTITY LIMIT PER SPECIFIC TIME PERIOD COUNT "DATA",9002313.91,20,5) 3P^^2087^^27 "DATA",9002313.91,20,10,0) ^9002313.9101^1^1^3150915^^ "DATA",9002313.91,20,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,21,0) 405^^DAYS SUPPLY^N^^^^3^N "DATA",9002313.91,21,5) D5^3^^4 "DATA",9002313.91,21,10,0) ^9002313.9101^1^1^3040109 "DATA",9002313.91,21,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Days Supply")) "DATA",9002313.91,21,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,21,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,21,25,0) ^9002313.9104^1^1^3030827^^^^ "DATA",9002313.91,21,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,21,30,0) ^9002313.9103^1^1^3030827^^^^ "DATA",9002313.91,21,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,5)=BPS("X") "DATA",9002313.91,22,0) 406^^COMPOUND CODE^N^^^^1^N "DATA",9002313.91,22,5) D6^407^^4 "DATA",9002313.91,22,10,0) ^9002313.9101^2^2^3040114 "DATA",9002313.91,22,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Compound Code")) "DATA",9002313.91,22,10,2,0) S:BPS("X")="" BPS("X")=1 "DATA",9002313.91,22,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,22,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,22,25,0) ^9002313.9104^1^1^3040114^^^^ "DATA",9002313.91,22,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,22,30,0) ^9002313.9103^1^1^3040114^^^^ "DATA",9002313.91,22,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,6)=BPS("X") "DATA",9002313.91,23,0) 407^^PRODUCT/SERVICE ID^A/N^^^^19^A/N "DATA",9002313.91,23,5) D7^19^^4 "DATA",9002313.91,23,10,0) ^9002313.9101^2^2^3030825 "DATA",9002313.91,23,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"NDC")) "DATA",9002313.91,23,10,2,0) S BPS("X")=$$NDCF^BPSECFM(BPS("X")) "DATA",9002313.91,23,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,23,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19) "DATA",9002313.91,23,25,0) ^9002313.9104^1^1^3030825^^^ "DATA",9002313.91,23,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19) "DATA",9002313.91,23,30,0) ^9002313.9103^1^1^3030825^^^^ "DATA",9002313.91,23,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,7)=BPS("X") "DATA",9002313.91,24,0) 408^^DAW PRODUCT SELECTION CODE^N^^^^1^A/N "DATA",9002313.91,24,1) DISPENSE AS WRITTEN (DAW)/ PRODUCT SELECTION CODE "DATA",9002313.91,24,5) D8^1^^4 "DATA",9002313.91,24,10,0) ^9002313.9101^2^2^3070205 "DATA",9002313.91,24,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"DAW")) "DATA",9002313.91,24,10,2,0) S:BPS("X")="" BPS("X")=0 "DATA",9002313.91,24,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,24,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,24,25,0) ^9002313.9104^1^1^3061120^ "DATA",9002313.91,24,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,24,30,0) ^9002313.9103^1^1^3030722^ "DATA",9002313.91,24,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,8)=BPS("X") "DATA",9002313.91,25,0) 409^^INGREDIENT COST SUBMITTED^D^^^^8^D "DATA",9002313.91,25,5) D9^8^^10 "DATA",9002313.91,25,10,0) ^^1^1^3121128 "DATA",9002313.91,25,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Ingredient Cost")) "DATA",9002313.91,25,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,25,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,25,25,0) ^9002313.9104^1^1^3040907^^^^ "DATA",9002313.91,25,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,25,30,0) ^9002313.9103^1^1^3040907^^^^ "DATA",9002313.91,25,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,9)=BPS("X") "DATA",9002313.91,26,0) 411^^PRESCRIBER ID^A/N^^^^15^A/N "DATA",9002313.91,26,5) DB^15^^6 "DATA",9002313.91,26,10,0) ^9002313.9101^1^1^3070214 "DATA",9002313.91,26,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber NPI")) "DATA",9002313.91,26,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,26,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,26,25,0) ^9002313.9104^1^1^3070214^ "DATA",9002313.91,26,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,26,30,0) ^9002313.9103^1^1^3030823^^^^ "DATA",9002313.91,26,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,11)=BPS("X") "DATA",9002313.91,27,0) 414^^DATE PRESCRIPTION WRITTEN^N^^^^8^N "DATA",9002313.91,27,5) DE^8^^4 "DATA",9002313.91,27,10,0) ^9002313.9101^1^1^3040913 "DATA",9002313.91,27,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Date Written")) "DATA",9002313.91,27,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,27,20,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,27,25,0) ^9002313.9104^1^1^3040913^^^^ "DATA",9002313.91,27,25,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,27,30,0) ^9002313.9103^1^1^3040913^^^^ "DATA",9002313.91,27,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,14)=BPS("X") "DATA",9002313.91,28,0) 415^^NUMBER OF REFILLS AUTHORIZED^N^^^^2^N "DATA",9002313.91,28,5) DF^2^^4 "DATA",9002313.91,28,10,0) ^9002313.9101^1^1^3030718 "DATA",9002313.91,28,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"# Refills")) "DATA",9002313.91,28,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,28,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,28,25,0) ^9002313.9104^1^1^3030718^^ "DATA",9002313.91,28,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,28,30,0) ^9002313.9103^1^1^3030718^^^^ "DATA",9002313.91,28,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,15)=BPS("X") "DATA",9002313.91,29,0) 419^^PRESCRIPTION ORIGIN CODE^N^^^^1^N "DATA",9002313.91,29,5) DJ^1^^4 "DATA",9002313.91,29,10,0) ^9002313.9101^2^2^3030721 "DATA",9002313.91,29,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Origin Code")) "DATA",9002313.91,29,10,2,0) S:BPS("X")="" BPS("X")="0" "DATA",9002313.91,29,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,29,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,29,25,0) ^9002313.9104^1^1^3030721^^^^ "DATA",9002313.91,29,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,29,30,0) ^9002313.9103^1^1^3030721^^^^ "DATA",9002313.91,29,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,19)=BPS("X") "DATA",9002313.91,30,0) 420^^SUBMISSION CLARIFICATION CODE^N^^^^2^N "DATA",9002313.91,30,5) DK^2^^4 "DATA",9002313.91,30,10,0) ^9002313.9101^1^1^3101006^^^^ "DATA",9002313.91,30,10,1,0) ; GET CODE handled by FLD420^BPSOSSG "DATA",9002313.91,30,20,0) ^9002313.9102^1^1^3101006^^^^ "DATA",9002313.91,30,20,1,0) ; vD.0 FORMAT CODE handled by FLD420^BPSOSSG "DATA",9002313.91,30,25,0) ^9002313.9104^1^1^3101006^^^^ "DATA",9002313.91,30,25,1,0) ; FORMAT CODE handled by FLD420^BPSOSSG "DATA",9002313.91,30,30,0) ^9002313.9103^1^1^3101006^^^^ "DATA",9002313.91,30,30,1,0) D FLD420^BPSOSSG "DATA",9002313.91,31,0) 453^^ORIG PRESCR PROD/SERV ID QUAL^N^^^^2^A/N "DATA",9002313.91,31,1) ORIGINALLY PRESCRIBED PRODUCT/SERVICE ID QUALIFIER "DATA",9002313.91,31,5) EJ^2^^4 "DATA",9002313.91,31,10,0) ^9002313.9101^1^1^3040907 "DATA",9002313.91,31,10,1,0) S BPS("X")="" "DATA",9002313.91,31,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,31,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,31,25,0) ^9002313.9104^1^1^3040907^^^^ "DATA",9002313.91,31,25,1,0) S BPS("X")=$$NFF^BPSECFM(BPS("X"),2) "DATA",9002313.91,31,30,0) ^9002313.9103^1^1^3040907^^^ "DATA",9002313.91,31,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,3)="" "DATA",9002313.91,32,0) B88^^QUAN LIMIT PER SPC TIME PERIOD^^^^^10^N "DATA",9002313.91,32,1) QUANTITY LIMIT PER SPECIFIC TIME PERIOD "DATA",9002313.91,32,5) 3R^^2088^^27 "DATA",9002313.91,32,10,0) ^^1^1^3150915^ "DATA",9002313.91,32,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,33,0) 423^^BASIS OF COST DETERMINATION^A/N^^^^2^A/N "DATA",9002313.91,33,5) DN^2^^10 "DATA",9002313.91,33,10,0) ^9002313.9101^1^1^3030916 "DATA",9002313.91,33,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Basis of Cost Determination")) "DATA",9002313.91,33,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,33,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,33,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,33,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,33,30,0) ^9002313.9103^1^1^3030916^^^^ "DATA",9002313.91,33,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,23)=BPS("X") "DATA",9002313.91,34,0) 424^^DIAGNOSIS CODE^A/N^^^^15^A/N "DATA",9002313.91,34,5) DO^15^^14 "DATA",9002313.91,34,10,0) ^9002313.9101^1^1^3030718 "DATA",9002313.91,34,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Diagnosis Code")) "DATA",9002313.91,34,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,34,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,34,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,34,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,34,30,0) ^9002313.9103^1^1^3030718^^ "DATA",9002313.91,34,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,24)=BPS("X") "DATA",9002313.91,35,0) 430^^GROSS AMOUNT DUE^D^^^^8^D "DATA",9002313.91,35,5) DU^8^^10 "DATA",9002313.91,35,10,0) ^9002313.9101^1^1^3030722 "DATA",9002313.91,35,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Gross Amount Due")) "DATA",9002313.91,35,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,35,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,35,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,35,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,35,30,0) ^9002313.9103^1^1^3030722^^^^ "DATA",9002313.91,35,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,30)=BPS("X") "DATA",9002313.91,36,0) 433^^PATIENT PAID AMOUNT REPORTED^D^^^^8^D "DATA",9002313.91,36,1) PATIENT PAID AMOUNT SUBMITTED "DATA",9002313.91,36,5) DX^8^^10 "DATA",9002313.91,36,10,0) ^^2^2^3110727^ "DATA",9002313.91,36,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Patient Paid Amount")) "DATA",9002313.91,36,10,2,0) S:BPS("X")="" BPS("X")="0.00" "DATA",9002313.91,36,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,36,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,36,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,36,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,36,30,0) ^9002313.9103^1^1^3030916^^ "DATA",9002313.91,36,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),430),U,3)=BPS("X") "DATA",9002313.91,37,0) 439^^REASON FOR SERVICE CODE^A/N^^^^2^A/N "DATA",9002313.91,37,5) E4^2^^9^29 "DATA",9002313.91,37,10,0) ^9002313.9101^1^1^3031230 "DATA",9002313.91,37,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"DUR","DUR Conflict Code",439)) "DATA",9002313.91,37,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,37,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,37,25,0) ^9002313.9104^1^1^3031230^^ "DATA",9002313.91,37,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,37,30,0) ^9002313.9103^1^1^3101115^^^^ "DATA",9002313.91,37,30,1,0) D FLD439^BPSOSSG "DATA",9002313.91,38,0) 440^^PROFESSIONAL SERVICE CODE^A/N^^^^2^A/N "DATA",9002313.91,38,5) E5^2^^9 "DATA",9002313.91,38,10,0) ^9002313.9101^1^1^3031230 "DATA",9002313.91,38,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"DUR","DUR Intervention Code",440)) "DATA",9002313.91,38,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,38,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,38,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,38,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,38,30,0) ^9002313.9103^1^1^3101115^ "DATA",9002313.91,38,30,1,0) D FLD440^BPSOSSG "DATA",9002313.91,39,0) 441^^RESULT OF SERVICE CODE^A/N^^^^2^A/N "DATA",9002313.91,39,5) E6^2^^9 "DATA",9002313.91,39,10,0) ^9002313.9101^2^2^3070214 "DATA",9002313.91,39,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"DUR","DUR Outcome Code",441)) "DATA",9002313.91,39,10,2,0) S:BPS("X")="" BPS("X")="00" "DATA",9002313.91,39,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,39,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,39,25,0) ^9002313.9104^1^1^3070214^^ "DATA",9002313.91,39,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,39,30,0) ^9002313.9103^1^1^3101115^ "DATA",9002313.91,39,30,1,0) D FLD441^BPSOSSG "DATA",9002313.91,40,0) 442^^QUANTITY DISPENSED^N^^^^10^N "DATA",9002313.91,40,5) E7^10^^4 "DATA",9002313.91,40,10,0) ^9002313.9101^1^1^3070620 "DATA",9002313.91,40,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Quantity"))*1000\1 "DATA",9002313.91,40,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,40,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,40,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,40,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,40,30,0) ^9002313.9103^1^1^3040109^^^^ "DATA",9002313.91,40,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),440),U,2)=BPS("X") "DATA",9002313.91,41,0) B89^^QUANTITY LIMIT TIME PERIOD^^^^^5^N "DATA",9002313.91,41,1) QUANTITY LIMIT TIME PERIOD "DATA",9002313.91,41,5) 3S^^2089^^27 "DATA",9002313.91,41,10,0) ^^1^1^3150915^ "DATA",9002313.91,41,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,42,0) 412^^DISPENSING FEE SUBMITTED^D^^^^8^D "DATA",9002313.91,42,5) DC^8^^10 "DATA",9002313.91,42,10,0) ^^1^1^3121128 "DATA",9002313.91,42,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Dispensing Fee")) "DATA",9002313.91,42,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,42,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,42,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,42,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,42,30,0) ^9002313.9103^1^1^3040907^^^^ "DATA",9002313.91,42,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,12)=BPS("X") "DATA",9002313.91,43,0) B90^^DAYS SUP LIM PER SPC TM PD CNT^^^^^1^N "DATA",9002313.91,43,1) DAYS SUPPLY LIMIT PER SPECIFIC TIME PERIOD COUNT "DATA",9002313.91,43,5) 3T^^2090^^27 "DATA",9002313.91,43,10,0) ^^1^1^3150915^ "DATA",9002313.91,43,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,44,0) 418^^LEVEL OF SERVICE^N^^^^2^N "DATA",9002313.91,44,5) DI^2^^4 "DATA",9002313.91,44,10,0) ^9002313.9101^2^2^3101115^ "DATA",9002313.91,44,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Level of Service")) "DATA",9002313.91,44,10,2,0) S:BPS("X")="" BPS("X")=0 "DATA",9002313.91,44,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,44,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,44,25,0) ^9002313.9104^1^1^3070215^^ "DATA",9002313.91,44,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,44,30,0) ^9002313.9103^1^1^3070215^^^^ "DATA",9002313.91,44,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,18)=BPS("X") "DATA",9002313.91,45,0) 421^^PRIMARY CARE PROVIDER ID^A/N^^^^15^A/N "DATA",9002313.91,45,5) DL^15^^6 "DATA",9002313.91,45,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,45,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Primary Care Provider NPI")) "DATA",9002313.91,45,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,45,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,45,25,0) ^9002313.9104^1^1^3070214^ "DATA",9002313.91,45,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,45,30,0) ^9002313.9103^1^1^3041015^ "DATA",9002313.91,45,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,21)="" "DATA",9002313.91,46,0) 426^^USUAL AND CUSTOMARY CHARGE^D^^^^8^D "DATA",9002313.91,46,5) DQ^8^^10 "DATA",9002313.91,46,10,0) ^9002313.9101^1^1^3031219 "DATA",9002313.91,46,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Usual & Customary")) "DATA",9002313.91,46,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,46,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,46,25,0) ^9002313.9104^1^1^3031219^^^^ "DATA",9002313.91,46,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,46,30,0) ^9002313.9103^1^1^3031219^^^^ "DATA",9002313.91,46,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,26)=BPS("X") "DATA",9002313.91,47,0) 429^^SPECIAL PACKAGING INDICATOR^N^^^^1^N "DATA",9002313.91,47,5) DT^1^^4 "DATA",9002313.91,47,10,0) ^9002313.9101^2^2^3101115^ "DATA",9002313.91,47,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Unit Dose Indicator")) "DATA",9002313.91,47,10,2,0) S:BPS("X")="" BPS("X")=0 "DATA",9002313.91,47,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,47,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,47,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,47,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,47,30,0) ^9002313.9103^1^1^3030823^^^ "DATA",9002313.91,47,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,29)=BPS("X") "DATA",9002313.91,48,0) 431^^OTHER PAYER AMOUNT PAID^D^^^^8^D "DATA",9002313.91,48,5) DV^8^^7 "DATA",9002313.91,48,10,0) ^9002313.9101^1^1^3100916 "DATA",9002313.91,48,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,48,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,48,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,48,25,0) ^9002313.9104^1^1^3101029^ "DATA",9002313.91,48,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,48,30,0) ^9002313.9103^1^1^3100824 "DATA",9002313.91,48,30,1,0) D SET431^BPSFLD01 "DATA",9002313.91,49,0) 438^^INCENTIVE AMOUNT SUBMITTED^D^^^^8^D "DATA",9002313.91,49,5) E3^8^^10 "DATA",9002313.91,49,10,0) ^^1^1^3110505^ "DATA",9002313.91,49,10,1,0) S BPS("X")=0 "DATA",9002313.91,49,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,49,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,49,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,49,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,49,30,0) ^9002313.9103^1^1^3040907^ "DATA",9002313.91,49,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),430),U,8)="" "DATA",9002313.91,50,0) B91^^DAYS SUP LIM PER SPC TM PERIOD^^^^^3^N "DATA",9002313.91,50,1) DAYS SUPPLY LIMIT PER SPECIFIC TIME PERIOD "DATA",9002313.91,50,5) 3W^^2091^^27 "DATA",9002313.91,50,10,0) ^^1^1^3150915^ "DATA",9002313.91,50,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,51,0) 443^^OTHER PAYER DATE^N^^^^8^N "DATA",9002313.91,51,5) E8^8^^7 "DATA",9002313.91,51,10,0) ^9002313.9101^1^1^3100916 "DATA",9002313.91,51,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,51,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,51,20,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,51,25,0) ^9002313.9104^1^1^3040224^ "DATA",9002313.91,51,25,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,51,30,0) ^9002313.9103^1^1^3100824 "DATA",9002313.91,51,30,1,0) D SET443^BPSFLD01 "DATA",9002313.91,52,0) 313^^CARDHOLDER LAST NAME^A/N^^^^15^A/N "DATA",9002313.91,52,5) CD^15^^3 "DATA",9002313.91,52,10,0) ^^1^1^3101216^ "DATA",9002313.91,52,10,1,0) S BPS("X")=$G(BPS("Cardholder","Last Name")) "DATA",9002313.91,52,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,52,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,52,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,52,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),15) "DATA",9002313.91,52,30,0) ^9002313.9103^1^1^3030823^^^^ "DATA",9002313.91,52,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,13)=BPS("X") "DATA",9002313.91,53,0) 312^^CARDHOLDER FIRST NAME^A/N^^^^12^A/N "DATA",9002313.91,53,5) CC^12^^3 "DATA",9002313.91,53,10,0) ^^1^1^3101216^ "DATA",9002313.91,53,10,1,0) S BPS("X")=$G(BPS("Cardholder","First Name")) "DATA",9002313.91,53,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,53,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12) "DATA",9002313.91,53,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,53,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),12) "DATA",9002313.91,53,30,0) ^9002313.9103^1^1^3101115^^^^ "DATA",9002313.91,53,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,12)=BPS("X") "DATA",9002313.91,54,0) 322^^PATIENT STREET ADDRESS^A/N^^^^30^A/N "DATA",9002313.91,54,5) CM^30^^2 "DATA",9002313.91,54,10,0) ^9002313.9101^1^1^3030718 "DATA",9002313.91,54,10,1,0) S BPS("X")=$G(BPS("Patient","Street Address")) "DATA",9002313.91,54,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,54,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,54,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,54,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),30) "DATA",9002313.91,54,30,0) ^9002313.9103^1^1^3030718^^^^ "DATA",9002313.91,54,30,1,0) S $P(^BPSC(BPS(9002313.02),321),U,2)=BPS("X") "DATA",9002313.91,55,0) 323^^PATIENT CITY ADDRESS^A/N^^^^20^A/N "DATA",9002313.91,55,5) CN^20^^2 "DATA",9002313.91,55,10,0) ^9002313.9101^1^1^3030703 "DATA",9002313.91,55,10,1,0) S BPS("X")=$G(BPS("Patient","City")) "DATA",9002313.91,55,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,55,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,55,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,55,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),20) "DATA",9002313.91,55,30,0) ^9002313.9103^1^1^3030703^^^^ "DATA",9002313.91,55,30,1,0) S $P(^BPSC(BPS(9002313.02),321),U,3)=BPS("X") "DATA",9002313.91,56,0) 324^^PATIENT STATE/PROVINCE ADDRESS^A/N^^^^2^A/N "DATA",9002313.91,56,5) CO^2^^2 "DATA",9002313.91,56,10,0) ^9002313.9101^1^1^3030717 "DATA",9002313.91,56,10,1,0) S BPS("X")=$G(BPS("Patient","State")) "DATA",9002313.91,56,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,56,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,56,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,56,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),2) "DATA",9002313.91,56,30,0) ^9002313.9103^1^1^3030717^^^^ "DATA",9002313.91,56,30,1,0) S $P(^BPSC(BPS(9002313.02),321),U,4)=BPS("X") "DATA",9002313.91,57,0) 325^^PATIENT ZIP/POSTAL ZONE^A/N^^^^15^A/N "DATA",9002313.91,57,5) CP^15^^2 "DATA",9002313.91,57,10,0) ^9002313.9101^1^1^3030718 "DATA",9002313.91,57,10,1,0) S BPS("X")=$G(BPS("Patient","Zip")) "DATA",9002313.91,57,20,0) ^^2^2^3121128 "DATA",9002313.91,57,20,1,0) S BPS("X")=$TR($G(BPS("X")),"-/._","") "DATA",9002313.91,57,20,2,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),15) "DATA",9002313.91,57,25,0) ^9002313.9104^2^2^3030718^^^^ "DATA",9002313.91,57,25,1,0) S BPS("X")=$TR(BPS("X"),"-/._","") "DATA",9002313.91,57,25,2,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),9) "DATA",9002313.91,57,30,0) ^9002313.9103^1^1^3030718^^^^ "DATA",9002313.91,57,30,1,0) S $P(^BPSC(BPS(9002313.02),321),U,5)=BPS("X") "DATA",9002313.91,58,0) 314^^HOME PLAN^A/N^^^^3^A/N "DATA",9002313.91,58,5) CE^3^^3 "DATA",9002313.91,58,10,0) ^9002313.9101^1^1^3030823 "DATA",9002313.91,58,10,1,0) S BPS("X")=$G(BPS("Home Plan")) "DATA",9002313.91,58,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,58,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,58,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,58,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),3) "DATA",9002313.91,58,30,0) ^9002313.9103^1^1^3030823^^^^ "DATA",9002313.91,58,30,1,0) S $P(^BPSC(BPS(9002313.02),300),U,14)=BPS("X") "DATA",9002313.91,59,0) 315^^EMPLOYER NAME^A/N^^^^30^A/N "DATA",9002313.91,59,5) CF^30^^8 "DATA",9002313.91,59,10,0) ^9002313.9101^2^2^3101115^ "DATA",9002313.91,59,10,1,0) D EMPL^BPSOSSG "DATA",9002313.91,59,10,2,0) S BPS("X")=$G(BPS("Employer","Name")) "DATA",9002313.91,59,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,59,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,59,25,0) ^9002313.9104^1^1^3030718^^^ "DATA",9002313.91,59,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),30) "DATA",9002313.91,59,30,0) ^9002313.9103^1^1^3061120^ "DATA",9002313.91,59,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),310),U,5)=BPS("X") "DATA",9002313.91,60,0) 316^^EMPLOYER STREET ADDRESS^A/N^^^^30^A/N "DATA",9002313.91,60,5) CG^30^^8 "DATA",9002313.91,60,10,0) ^9002313.9101^1^1^3030718 "DATA",9002313.91,60,10,1,0) S BPS("X")=$G(BPS("Employer","Address")) "DATA",9002313.91,60,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,60,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,60,25,0) ^9002313.9104^1^1^3030718^^^ "DATA",9002313.91,60,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),30) "DATA",9002313.91,60,30,0) ^9002313.9103^1^1^3061120^ "DATA",9002313.91,60,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),310),U,6)=BPS("X") "DATA",9002313.91,61,0) 317^^EMPLOYER CITY ADDRESS^A/N^^^^20^A/N "DATA",9002313.91,61,5) CH^20^^8 "DATA",9002313.91,61,10,0) ^9002313.9101^1^1^3150112^ "DATA",9002313.91,61,10,1,0) S BPS("X")=$G(BPS("Employer","City")) "DATA",9002313.91,61,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,61,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,61,25,0) ^9002313.9104^1^1^3030718^^ "DATA",9002313.91,61,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),20) "DATA",9002313.91,61,30,0) ^9002313.9103^1^1^3061120^ "DATA",9002313.91,61,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),310),U,7)=BPS("X") "DATA",9002313.91,62,0) 318^^EMPLOYER STATE/PROV ADDRESS^A/N^^^^2^A/N "DATA",9002313.91,62,1) EMPLOYER STATE/ PROVINCE ADDRESS "DATA",9002313.91,62,5) CI^2^^8 "DATA",9002313.91,62,10,0) ^9002313.9101^1^1^3030718 "DATA",9002313.91,62,10,1,0) S BPS("X")=$G(BPS("Employer","State")) "DATA",9002313.91,62,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,62,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,62,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,62,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),2) "DATA",9002313.91,62,30,0) ^9002313.9103^1^1^3061120^ "DATA",9002313.91,62,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),310),U,8)=BPS("X") "DATA",9002313.91,63,0) 319^^EMPLOYER ZIP/POSTAL ZONE^A/N^^^^15^A/N "DATA",9002313.91,63,5) CJ^15^^8 "DATA",9002313.91,63,10,0) ^9002313.9101^1^1^3030718 "DATA",9002313.91,63,10,1,0) S BPS("X")=$G(BPS("Employer","Zip Code")) "DATA",9002313.91,63,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,63,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,63,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,63,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),15) "DATA",9002313.91,63,30,0) ^9002313.9103^1^1^3061120^ "DATA",9002313.91,63,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),310),U,9)=BPS("X") "DATA",9002313.91,64,0) 327^^CARRIER ID^A/N^^^^10^A/N "DATA",9002313.91,64,5) CR^12^^8 "DATA",9002313.91,64,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,64,10,1,0) S BPS("X")=$G(BPS("Carrier ID #")) "DATA",9002313.91,64,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,64,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,64,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,64,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),12) "DATA",9002313.91,64,30,0) ^9002313.9103^1^1^3061120^ "DATA",9002313.91,64,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),320),U,7)=BPS("X") "DATA",9002313.91,65,0) B92^^DAYS SUPPLY LIMIT TIME PERIOD^^^^^5^N "DATA",9002313.91,65,1) DAYS SUPPLY LIMIT TIME PERIOD "DATA",9002313.91,65,5) 3X^^2092^^27 "DATA",9002313.91,65,10,0) ^^1^1^3150915^ "DATA",9002313.91,65,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,66,0) C01^^ORIG MANUFACTURER PRODUCT ID^A/N^^^^19^A/N "DATA",9002313.91,66,1) ORIGINAL MANUFACTURER PRODUCT ID "DATA",9002313.91,66,5) 4N^19^2101^4 "DATA",9002313.91,66,10,0) ^9002313.9101^1^1^3171117^^^ "DATA",9002313.91,66,10,1,0) S BPS("X")="" "DATA",9002313.91,66,20,0) ^9002313.9102^1^1^3171117^^ "DATA",9002313.91,66,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19) "DATA",9002313.91,66,25,0) ^9002313.9104^1^1^3171117^^^ "DATA",9002313.91,66,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19) "DATA",9002313.91,66,30,0) ^9002313.9103^1^1^3171117^^ "DATA",9002313.91,66,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C0"),U,1)=BPS("X") "DATA",9002313.91,67,0) 427^^PRESCRIBER LAST NAME^A/N^^^^15^A/N "DATA",9002313.91,67,5) DR^15^^6 "DATA",9002313.91,67,10,0) ^9002313.9101^1^1^3110107^^ "DATA",9002313.91,67,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Last Name")) "DATA",9002313.91,67,20,0) ^9002313.9102^1^1^3110107^ "DATA",9002313.91,67,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,67,25,0) ^9002313.9104^1^1^3110107^^ "DATA",9002313.91,67,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),15) "DATA",9002313.91,67,30,0) ^9002313.9103^1^1^3110107^^^^ "DATA",9002313.91,67,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),420),U,27)=BPS("X") "DATA",9002313.91,68,0) C02^^ORIG MANUFACTURER PROD ID QUAL^A/N^^^^2^A/N "DATA",9002313.91,68,1) ORIGINAL MANUFACTURER PRODUCT ID QUALIFIER "DATA",9002313.91,68,5) 4P^2^2102^4 "DATA",9002313.91,68,10,0) ^^1^1^3170228^ "DATA",9002313.91,68,10,1,0) S BPS("X")="" "DATA",9002313.91,68,20,0) ^^1^1^3170228^ "DATA",9002313.91,68,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,68,25,0) ^^1^1^3170228^ "DATA",9002313.91,68,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,68,30,0) ^^1^1^3170228^ "DATA",9002313.91,68,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C0"),U,2)=BPS("X") "DATA",9002313.91,69,0) 434^^DATE OF INJURY^N^^^^8^N "DATA",9002313.91,69,5) DY^8^^8 "DATA",9002313.91,69,10,0) ^9002313.9101^2^2^3101115^ "DATA",9002313.91,69,10,1,0) S BPS("X")=$G(BPS("Date of Injury")) "DATA",9002313.91,69,10,2,0) S BPS("X")=$$DTF1^BPSECFM(BPS("X")) "DATA",9002313.91,69,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,69,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,69,25,0) ^9002313.9104^1^1^3031210^^ "DATA",9002313.91,69,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,69,30,0) ^9002313.9103^1^1^3010125^^ "DATA",9002313.91,69,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),430),U,4)=BPS("X") "DATA",9002313.91,70,0) 435^^CLAIM/REFERENCE ID^A/N^^^^30^A/N "DATA",9002313.91,70,5) DZ^30^^8 "DATA",9002313.91,70,10,0) ^9002313.9101^1^1^3030718 "DATA",9002313.91,70,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Claim/Ref ID #")) "DATA",9002313.91,70,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,70,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,70,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,70,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),30) "DATA",9002313.91,70,30,0) ^9002313.9103^1^1^3030718^^^^ "DATA",9002313.91,70,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,35)=BPS("X") "DATA",9002313.91,71,0) 436^^PRODUCT/SERVICE ID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,71,5) E1^2^^4 "DATA",9002313.91,71,10,0) ^^1^1^3121128 "DATA",9002313.91,71,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Product ID Qualifier")) "DATA",9002313.91,71,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,71,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,71,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,71,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),2) "DATA",9002313.91,71,30,0) ^9002313.9103^1^1^3040107^^^^ "DATA",9002313.91,71,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),430),U,6)=BPS("X") "DATA",9002313.91,72,0) B96^^PROVIDER FIRST NAME^A/N^^^^35^A/N "DATA",9002313.91,72,1) PROVIDER FIRST NAME "DATA",9002313.91,72,5) 4A^35^2096^5 "DATA",9002313.91,72,10,0) ^^1^1^3170228^ "DATA",9002313.91,72,10,1,0) S BPS("X")="" "DATA",9002313.91,72,20,0) ^^1^1^3170228^ "DATA",9002313.91,72,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35) "DATA",9002313.91,72,25,0) ^^1^1^3170228^ "DATA",9002313.91,72,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35) "DATA",9002313.91,72,30,0) ^^1^1^3170306^ "DATA",9002313.91,72,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B90"),U,6)=BPS("X") "DATA",9002313.91,73,0) B97^^PROVIDER LAST NAME^A/N^^^^35^A/N "DATA",9002313.91,73,1) PROVIDER LAST NAME "DATA",9002313.91,73,5) 4M^35^2097^5 "DATA",9002313.91,73,10,0) ^^1^1^3170228^ "DATA",9002313.91,73,10,1,0) S BPS("X")="" "DATA",9002313.91,73,20,0) ^^1^1^3170228^ "DATA",9002313.91,73,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35) "DATA",9002313.91,73,25,0) ^^1^1^3170228^ "DATA",9002313.91,73,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35) "DATA",9002313.91,73,30,0) ^^1^1^3170306^ "DATA",9002313.91,73,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B90"),U,7)=BPS("X") "DATA",9002313.91,74,0) 498.51^^PRIOR AUTH PROCESSED DATE^A/N^^^^8^N "DATA",9002313.91,74,5) PR^8^^^30 "DATA",9002313.91,74,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,74,10,1,0) S BPS("X")="" "DATA",9002313.91,74,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,74,20,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,75,0) 202^^SERV PROVIDER ID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,75,1) SERVICE PROVIDER ID QUALIFIER "DATA",9002313.91,75,5) B2^2^^1^22 "DATA",9002313.91,75,10,0) ^9002313.9101^1^1^3070214 "DATA",9002313.91,75,10,1,0) S BPS("X")="01" "DATA",9002313.91,75,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,75,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,75,25,0) ^9002313.9104^1^1^3070214^ "DATA",9002313.91,75,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,75,30,0) ^9002313.9103^1^1^3040114^^^^ "DATA",9002313.91,75,30,1,0) S $P(^BPSC(BPS(9002313.02),200),U,2)=BPS("X") ;VA "DATA",9002313.91,76,0) 110^^SOFTWARE VENDOR/CERT ID^A/N^^^^10^A/N "DATA",9002313.91,76,1) SOFTWARE VENDOR/ CERTIFICATION ID "DATA",9002313.91,76,5) AK^10^^1 "DATA",9002313.91,76,10,0) ^9002313.9101^1^1^3061023 "DATA",9002313.91,76,10,1,0) S BPS("X")=$G(BPS("NCPDP","Software Vendor/Cert ID")) "DATA",9002313.91,76,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,76,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,76,25,0) ^9002313.9104^1^1^3040202^^^^ "DATA",9002313.91,76,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) ;VA "DATA",9002313.91,76,30,0) ^9002313.9103^1^1^3061023^ "DATA",9002313.91,76,30,1,0) S $P(^BPSC(BPS(9002313.02),100),U,10)=BPS("X") "DATA",9002313.91,77,0) 331^^PATIENT ID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,77,5) CX^2^^2 "DATA",9002313.91,77,10,0) ^^1^1^3220210^ "DATA",9002313.91,77,10,1,0) S BPS("X")="01" "DATA",9002313.91,77,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,77,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,77,25,0) ^9002313.9104^1^1^3030718^^ "DATA",9002313.91,77,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,77,30,0) ^9002313.9103^1^1^3030718^^^^ "DATA",9002313.91,77,30,1,0) S $P(^BPSC(BPS(9002313.02),330),U,1)=BPS("X") ;VA "DATA",9002313.91,78,0) 332^^PATIENT ID^A/N^^^^20^A/N "DATA",9002313.91,78,5) CY^20^^2 "DATA",9002313.91,78,10,0) ^^1^1^3220210^ "DATA",9002313.91,78,10,1,0) S BPS("X")=$G(BPS("Patient","SSN")) "DATA",9002313.91,78,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,78,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,78,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,78,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,78,30,0) ^9002313.9103^1^1^3040820^^^^ "DATA",9002313.91,78,30,1,0) S $P(^BPSC(BPS(9002313.02),330),U,2)=BPS("X") ;VA "DATA",9002313.91,79,0) 326^^PATIENT TELEPHONE NUMBER^N^^^^10^N "DATA",9002313.91,79,5) CQ^10^^2 "DATA",9002313.91,79,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,79,10,1,0) S BPS("X")=$TR($G(BPS("Patient","Phone #")),"#() -_*.@") "DATA",9002313.91,79,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,79,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,79,25,0) ^9002313.9104^1^1^3101115^ "DATA",9002313.91,79,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,79,30,0) ^9002313.9103^1^1^3101115^ "DATA",9002313.91,79,30,1,0) S $P(^BPSC(BPS(9002313.02),321),U,6)=BPS("X") "DATA",9002313.91,80,0) 455^^PRESCRIPTION/SERV REF NO QLFR^A/N^^^^1^A/N "DATA",9002313.91,80,1) PRESCRIPTION/ SERVICE REFERENCE NUMBER QUALIFIER "DATA",9002313.91,80,5) EM^1^^4^27 "DATA",9002313.91,80,10,0) ^9002313.9101^1^1^3101008^ "DATA",9002313.91,80,10,1,0) S BPS("X")=1 "DATA",9002313.91,80,20,0) ^9002313.9102^1^1^3101007^^ "DATA",9002313.91,80,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,80,25,0) ^9002313.9104^1^1^3101007^^^ "DATA",9002313.91,80,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,80,30,0) ^9002313.9103^1^1^3101007^^^^ "DATA",9002313.91,80,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,5)=BPS("X") "DATA",9002313.91,81,0) 460^^QUANTITY PRESCRIBED^N^^^^10^N "DATA",9002313.91,81,5) ET^10^^4 "DATA",9002313.91,81,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,81,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Quantity"))*1000\1 "DATA",9002313.91,81,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,81,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,81,25,0) ^9002313.9104^1^1^3030827^^^^ "DATA",9002313.91,81,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,81,30,0) ^9002313.9103^1^1^3101115^ "DATA",9002313.91,81,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,10)=BPS("X") "DATA",9002313.91,82,0) 465^^PROVIDER ID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,82,5) EY^2^^5 "DATA",9002313.91,82,10,0) ^9002313.9101^1^1^3070214 "DATA",9002313.91,82,10,1,0) S BPS("X")="05" "DATA",9002313.91,82,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,82,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,82,25,0) ^9002313.9104^1^1^3070214^ "DATA",9002313.91,82,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,82,30,0) ^9002313.9103^1^1^3041015^ "DATA",9002313.91,82,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,5)="" "DATA",9002313.91,83,0) 444^^PROVIDER ID^A/N^^^^15^A/N "DATA",9002313.91,83,5) E9^15^^5 "DATA",9002313.91,83,10,0) ^9002313.9101^1^1^3070214 "DATA",9002313.91,83,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Provider NPI")) "DATA",9002313.91,83,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,83,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,83,25,0) ^9002313.9104^1^1^3070214^ "DATA",9002313.91,83,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,83,30,0) ^9002313.9103^1^1^3041015^ "DATA",9002313.91,83,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),440),U,4)="" "DATA",9002313.91,84,0) 466^^PRESCRIBER ID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,84,5) EZ^2^^6 "DATA",9002313.91,84,10,0) ^^2^2^3101216^ "DATA",9002313.91,84,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber ID Qualifier")) "DATA",9002313.91,84,10,2,0) S:BPS("X")="" BPS("X")="01" "DATA",9002313.91,84,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,84,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,84,25,0) ^9002313.9104^1^1^3070214^^^^ "DATA",9002313.91,84,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,84,30,0) ^9002313.9103^1^1^3030823^^^^ "DATA",9002313.91,84,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,6)=BPS("X") "DATA",9002313.91,85,0) 467^^PRESCRIBER LOCATION CODE^A/N^^^^3^A/N "DATA",9002313.91,85,5) 1E^3 "DATA",9002313.91,85,10,0) ^^3^3^3211228^ "DATA",9002313.91,85,10,1,0) S BPS("X")=$G(BPS("RX",1,"Prescriber Billing Location")) "DATA",9002313.91,85,10,2,0) ; Field 467-1E was added to file 9002313.91 in error. It should never "DATA",9002313.91,85,10,3,0) ; appear on a payer sheet, and it should never be populated. "DATA",9002313.91,85,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,85,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,85,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,85,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,85,30,0) ^9002313.9103^1^1^3030721^^^^ "DATA",9002313.91,85,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,7)=BPS("X") "DATA",9002313.91,86,0) 498^^PRESCRIBER TELEPHONE NUMBER^N^^^^10^N "DATA",9002313.91,86,5) PM^10^^6 "DATA",9002313.91,86,10,0) ^9002313.9101^1^1^3101029^ "DATA",9002313.91,86,10,1,0) S BPS("X")=$TR($G(BPS("RX",BPS(9002313.0201),"Prescriber Phone #")),"#() -_*.@") "DATA",9002313.91,86,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,86,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,86,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,86,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,86,30,0) ^9002313.9103^1^1^3100917^^^^ "DATA",9002313.91,86,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),498),U,12)=BPS("X") "DATA",9002313.91,87,0) 468^^PRIMARY CARE PROVIDER ID QLFR^A/N^^^^2^A/N "DATA",9002313.91,87,1) PRIMARY CARE PROVIDER ID QUALIFIER "DATA",9002313.91,87,5) 2E^2^^6 "DATA",9002313.91,87,10,0) ^^2^2^3110727^ "DATA",9002313.91,87,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Primary Care Prov ID Qual")) "DATA",9002313.91,87,10,2,0) S:BPS("X")="" BPS("X")="01" "DATA",9002313.91,87,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,87,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,87,25,0) ^9002313.9104^1^1^3070214^^^^ "DATA",9002313.91,87,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,87,30,0) ^9002313.9103^1^1^3041015^ "DATA",9002313.91,87,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,8)="" "DATA",9002313.91,88,0) 469^^PRIM CARE PROV LOCATION CODE^N^^^^3^A/N "DATA",9002313.91,88,5) H5^3 "DATA",9002313.91,88,10,0) ^^3^3^3211228^ "DATA",9002313.91,88,10,1,0) S BPS("X")=$G(BPS("Patient","Primary Care Prov Location Code")) "DATA",9002313.91,88,10,2,0) ; Field 469-H5 was added to file 9002313.91 in error. It should never "DATA",9002313.91,88,10,3,0) ; appear on a payer sheet, and it should never be populated. "DATA",9002313.91,88,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,88,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,88,25,0) ^9002313.9104^1^1^3040114^^^^ "DATA",9002313.91,88,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,88,30,0) ^9002313.9103^1^1^3040114^^^^ "DATA",9002313.91,88,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,9)=BPS("X") "DATA",9002313.91,89,0) 470^^PRIM CARE PROVIDER LAST NAME^A/N^^^^15^A/N "DATA",9002313.91,89,1) PRIMARY CARE PROVIDER LAST NAME "DATA",9002313.91,89,5) 4E^15^^6 "DATA",9002313.91,89,10,0) ^^1^1^3101217^ "DATA",9002313.91,89,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Primary Care Prov Last Name")) "DATA",9002313.91,89,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,89,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,89,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,89,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),15) "DATA",9002313.91,89,30,0) ^9002313.9103^1^1^3030825^^^^ "DATA",9002313.91,89,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,10)=BPS("X") "DATA",9002313.91,90,0) B95^^FACILITY ID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,90,1) FACILITY ID QUALIFIER "DATA",9002313.91,90,5) 3Z^2^2095^16 "DATA",9002313.91,90,10,0) ^9002313.9101^2^2^3170530^^^ "DATA",9002313.91,90,10,1,0) S BPS("X")=$G(BPS("Insurer","Facility ID")) "DATA",9002313.91,90,10,2,0) S BPS("X")=$S(BPS("X")'="":1,1:"") "DATA",9002313.91,90,20,0) ^9002313.9102^1^1^3170530^^^ "DATA",9002313.91,90,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,90,25,0) ^9002313.9104^1^1^3170530^^^ "DATA",9002313.91,90,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,90,30,0) ^9002313.9103^1^1^3170530^^^ "DATA",9002313.91,90,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B90"),U,1)=BPS("X") "DATA",9002313.91,91,0) 480^^OTHER AMT CLAIMED SUBMITTED^D^^^^8^D "DATA",9002313.91,91,1) OTHER AMOUNT CLAIMED SUBMITTED "DATA",9002313.91,91,5) H9^8^^10 "DATA",9002313.91,91,10,0) ^9002313.9101^1^1^3101006^^^^ "DATA",9002313.91,91,10,1,0) ; GET CODE handled by FLD480^BPSOSSG "DATA",9002313.91,91,20,0) ^9002313.9102^1^1^3101006^^^^ "DATA",9002313.91,91,20,1,0) ; vD.0 format code handled by FLD480^BPSOSSG "DATA",9002313.91,91,25,0) ^9002313.9104^1^1^3101006^^^^ "DATA",9002313.91,91,25,1,0) ; format code handled by FLD480^BPSOSSG "DATA",9002313.91,91,30,0) ^9002313.9103^1^1^3101006^^^^ "DATA",9002313.91,91,30,1,0) D FLD480^BPSOSSG "DATA",9002313.91,92,0) 109^^TRANSACTION COUNT^A/N^^^^1^A/N "DATA",9002313.91,92,5) A9^1^^1^22 "DATA",9002313.91,92,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,92,10,1,0) S BPS("X")=$G(BPS("Transaction Count")) "DATA",9002313.91,92,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,92,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,92,25,0) ^9002313.9104^1^1^3040114^^^^ "DATA",9002313.91,92,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,92,30,0) ^9002313.9103^1^1^3040114^^^ "DATA",9002313.91,92,30,1,0) S $P(^BPSC(BPS(9002313.02),100),U,9)=BPS("X") "DATA",9002313.91,93,0) 111^^SEGMENT IDENTIFICATION^A/N^^^^2^A/N "DATA",9002313.91,93,5) AM^2^^1 "DATA",9002313.91,93,10,0) ^9002313.9101^1^1^3040114 "DATA",9002313.91,93,10,1,0) S BPS("X")="" "DATA",9002313.91,93,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,93,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,94,0) B98^^RECONCILIATION ID^A/N^^^^30^A/N "DATA",9002313.91,94,1) RECONCILIATION ID "DATA",9002313.91,94,5) 34^30^2098^4^26 "DATA",9002313.91,94,10,0) ^9002313.9101^1^1^3171120^ "DATA",9002313.91,94,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,95,0) 112^^TRANSACTION RESPONSE STATUS^A/N^^^^1^A/N "DATA",9002313.91,95,5) AN^2^^^26 "DATA",9002313.91,95,10,0) ^9002313.9101^1^1^3171117^^^ "DATA",9002313.91,95,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,95,25,0) ^9002313.9104^1^1^3171117^^^ "DATA",9002313.91,95,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,95,30,0) ^9002313.9103^1^1^3171117^^^ "DATA",9002313.91,95,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),110),U,2)=BPS("X") "DATA",9002313.91,96,0) 320^^EMPLOYER TELEPHONE NUMBER^N^^^^10^N "DATA",9002313.91,96,5) CK^10^^8 "DATA",9002313.91,96,10,0) ^9002313.9101^1^1^3050802 "DATA",9002313.91,96,10,1,0) S BPS("X")=$TR($G(BPS("Employer","Phone")),"#() -_*.@") "DATA",9002313.91,96,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,96,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,96,25,0) ^9002313.9104^1^1^3061121^ "DATA",9002313.91,96,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),10) "DATA",9002313.91,96,30,0) ^9002313.9103^1^1^3061120^ "DATA",9002313.91,96,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),310),U,10)=BPS("X") "DATA",9002313.91,97,0) 321^^EMPLOYER CONTACT NAME^A/N^^^^30^A/N "DATA",9002313.91,97,5) CL^30^^8 "DATA",9002313.91,97,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,97,10,1,0) S BPS("X")="" "DATA",9002313.91,97,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,97,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,97,25,0) ^9002313.9104^1^1^3040224^^^ "DATA",9002313.91,97,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),30) "DATA",9002313.91,97,30,0) ^9002313.9103^1^1^3040224^ "DATA",9002313.91,97,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),320),U,1)=BPS("X") "DATA",9002313.91,98,0) 330^^ALTERNATE ID^A/N^^^^20^A/N "DATA",9002313.91,98,5) CW^20^^4 "DATA",9002313.91,98,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,98,10,1,0) S BPS("X")="" "DATA",9002313.91,98,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,98,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,98,25,0) ^9002313.9104^1^1^3040224^^^ "DATA",9002313.91,98,25,1,0) S BPS("X")=$$NFF^BPSECFM(BPS("X"),20) "DATA",9002313.91,98,30,0) ^9002313.9103^1^1^3040224^^ "DATA",9002313.91,98,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),320),U,10)=BPS("X") "DATA",9002313.91,99,0) 333^^EMPLOYER ID^A/N^^^^15^A/N "DATA",9002313.91,99,5) CZ^15^^2 "DATA",9002313.91,99,10,0) ^9002313.9101^1^1^3030823 "DATA",9002313.91,99,10,1,0) S BPS("X")="" "DATA",9002313.91,99,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,99,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,99,25,0) ^9002313.9104^1^1^3030823^ "DATA",9002313.91,99,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,99,30,0) ^9002313.9103^1^1^3030823^^^^ "DATA",9002313.91,99,30,1,0) S $P(^BPSC(BPS(9002313.02),330),U,3)=BPS("X") "DATA",9002313.91,100,0) 334^^SMOKER/NONSMOKER^N^^^^1^A/N "DATA",9002313.91,100,5) 1C^1^^2 "DATA",9002313.91,100,10,0) ^9002313.9101^1^1^3070620 "DATA",9002313.91,100,10,1,0) S BPS("X")="" "DATA",9002313.91,100,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,100,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,100,25,0) ^9002313.9104^1^1^3040114^^^^ "DATA",9002313.91,100,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),1) "DATA",9002313.91,100,30,0) ^9002313.9103^1^1^3040114^^^^ "DATA",9002313.91,100,30,1,0) S $P(^BPSC(BPS(9002313.02),330),U,4)=BPS("X") "DATA",9002313.91,101,0) 335^^PREGNANCY INDICATOR^N^^^^1^A/N "DATA",9002313.91,101,5) 2C^1^^2 "DATA",9002313.91,101,10,0) ^9002313.9101^1^1^3030823 "DATA",9002313.91,101,10,1,0) S BPS("X")="" "DATA",9002313.91,101,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,101,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,101,25,0) ^9002313.9104^1^1^3030823^^ "DATA",9002313.91,101,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),1) "DATA",9002313.91,101,30,0) ^9002313.9103^1^1^3030823^^ "DATA",9002313.91,101,30,1,0) S $P(^BPSC(BPS(9002313.02),330),U,5)=BPS("X") "DATA",9002313.91,102,0) 336^^FACILITY ID^A/N^^^^10^A/N "DATA",9002313.91,102,5) 8C^10^^16 "DATA",9002313.91,102,10,0) ^9002313.9101^1^1^3070103 "DATA",9002313.91,102,10,1,0) S BPS("X")=$G(BPS("Insurer","Facility ID")) "DATA",9002313.91,102,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,102,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,102,25,0) ^9002313.9104^1^1^3030823^^ "DATA",9002313.91,102,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),10) "DATA",9002313.91,102,30,0) ^9002313.9103^1^1^3030823^ "DATA",9002313.91,102,30,1,0) S $P(^BPSC(BPS(9002313.02),330),U,6)=BPS("X") "DATA",9002313.91,103,0) 337^^COB/OTHER PAYMENTS COUNT^N^^^^1^N "DATA",9002313.91,103,1) COORDINATION OF BENEFITS/OTHER PAYMENTS COUNT "DATA",9002313.91,103,5) 4C^1^^7 "DATA",9002313.91,103,10,0) ^9002313.9101^1^1^3100916 "DATA",9002313.91,103,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,103,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,103,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,103,25,0) ^9002313.9104^1^1^3040223^^^ "DATA",9002313.91,103,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,103,30,0) ^9002313.9103^1^1^3100824 "DATA",9002313.91,103,30,1,0) D SET337^BPSFLD01 "DATA",9002313.91,104,0) 338^^OTHER PAYER COVERAGE TYPE^N^^^^2^A/N "DATA",9002313.91,104,5) 5C^2^^7^31 "DATA",9002313.91,104,10,0) ^9002313.9101^1^1^3100916 "DATA",9002313.91,104,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,104,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,104,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,104,25,0) ^9002313.9104^1^1^3101029^ "DATA",9002313.91,104,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,104,30,0) ^9002313.9103^1^1^3101004^ "DATA",9002313.91,104,30,1,0) D SET338^BPSFLD01 "DATA",9002313.91,105,0) 339^^OTHER PAYER ID QUALIFIER^N^^^^2^A/N "DATA",9002313.91,105,5) 6C^2^^7^31 "DATA",9002313.91,105,10,0) ^9002313.9101^1^1^3100916 "DATA",9002313.91,105,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,105,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,105,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,105,25,0) ^9002313.9104^1^1^3101029^ "DATA",9002313.91,105,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,105,30,0) ^9002313.9103^1^1^3101004^ "DATA",9002313.91,105,30,1,0) D SET339^BPSFLD01 "DATA",9002313.91,106,0) 340^^OTHER PAYER ID^A/N^^^^10^A/N "DATA",9002313.91,106,5) 7C^10^^7^31 "DATA",9002313.91,106,10,0) ^9002313.9101^1^1^3100916 "DATA",9002313.91,106,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,106,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,106,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,106,25,0) ^9002313.9104^1^1^3040223^^ "DATA",9002313.91,106,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,106,30,0) ^9002313.9103^1^1^3101004^^ "DATA",9002313.91,106,30,1,0) D SET340^BPSFLD01 "DATA",9002313.91,107,0) 341^^OTHER PAYER AMOUNT PAID COUNT^N^^^^1^N "DATA",9002313.91,107,5) HB^1^^7 "DATA",9002313.91,107,10,0) ^9002313.9101^1^1^3100916 "DATA",9002313.91,107,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,107,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,107,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,107,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,107,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,107,30,0) ^9002313.9103^1^1^3100824 "DATA",9002313.91,107,30,1,0) D SET341^BPSFLD01 "DATA",9002313.91,108,0) 342^^OTHER PAYER AMT PAID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,108,1) OTHER PAYER AMOUNT PAID QUALIFIER "DATA",9002313.91,108,5) HC^2^^7 "DATA",9002313.91,108,10,0) ^9002313.9101^1^1^3100916 "DATA",9002313.91,108,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,108,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,108,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,108,25,0) ^9002313.9104^1^1^3101029^ "DATA",9002313.91,108,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,108,30,0) ^9002313.9103^1^1^3100824 "DATA",9002313.91,108,30,1,0) D SET342^BPSFLD01 "DATA",9002313.91,109,0) 343^^DISPENSING STATUS^A/N^^^^1^A/N "DATA",9002313.91,109,5) HD^1^^4 "DATA",9002313.91,109,10,0) ^9002313.9101^1^1^3040913 "DATA",9002313.91,109,10,1,0) S BPS("X")="" "DATA",9002313.91,109,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,109,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,109,25,0) ^9002313.9104^1^1^3040913^^^^ "DATA",9002313.91,109,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,109,30,0) ^9002313.9103^1^1^3070620^ "DATA",9002313.91,109,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),340),U,3)="" "DATA",9002313.91,110,0) 344^^QTY INTENDED TO BE DISPENSED^N^^^^10^N "DATA",9002313.91,110,1) QUANTITY INTENDED TO BE DISPENSED "DATA",9002313.91,110,5) HF^10^^4 "DATA",9002313.91,110,10,0) ^9002313.9101^1^1^3070620 "DATA",9002313.91,110,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Quantity"))*1000\1 "DATA",9002313.91,110,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,110,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,110,25,0) ^9002313.9104^1^1^3070620^ "DATA",9002313.91,110,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,110,30,0) ^9002313.9103^1^1^3070620^ "DATA",9002313.91,110,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),340),U,4)="" "DATA",9002313.91,111,0) 345^^DAYS SUPPLY INTEND TO BE DISP^N^^^^3^N "DATA",9002313.91,111,1) DAYS SUPPLY INTENDED TO BE DISPENSED "DATA",9002313.91,111,5) HG^3^^4 "DATA",9002313.91,111,10,0) ^9002313.9101^1^1^3030827 "DATA",9002313.91,111,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Days Supply"))*1000 "DATA",9002313.91,111,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,111,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,111,25,0) ^9002313.9104^1^1^3030827^^^ "DATA",9002313.91,111,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,111,30,0) ^9002313.9103^1^1^3070620^ "DATA",9002313.91,111,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),340),U,5)="" "DATA",9002313.91,112,0) 346^^BASIS OF CALC - DISPENSING FEE^A/N^^^^2^A/N "DATA",9002313.91,112,5) HH^8^^^28 "DATA",9002313.91,112,10,0) ^9002313.9101^1^1^3171117^^ "DATA",9002313.91,112,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,112,25,0) ^9002313.9104^1^1^3171117^^ "DATA",9002313.91,112,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,112,30,0) ^9002313.9103^1^1^3171117^^ "DATA",9002313.91,112,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),340),U,6)=BPS("X") "DATA",9002313.91,113,0) 347^^BASIS OF CALC - COPAY^A/N^^^^2^A/N "DATA",9002313.91,113,5) HJ^8^^^28 "DATA",9002313.91,113,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,113,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,113,25,0) ^9002313.9104^1^1^3040114^^^ "DATA",9002313.91,113,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,113,30,0) ^9002313.9103^1^1^3040114^^^ "DATA",9002313.91,113,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),340),U,7)=BPS("X") "DATA",9002313.91,114,0) 348^^BASIS OF CALC - REGULATORY FEE^A/N^^^^2^A/N "DATA",9002313.91,114,5) HK^8^^^28 "DATA",9002313.91,114,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,114,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,114,25,0) ^^1^1^3031205^ "DATA",9002313.91,114,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,114,30,0) ^^1^1^3031205^ "DATA",9002313.91,114,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),340),U,8)=BPS("X") "DATA",9002313.91,115,0) 349^^BASIS OF CALC - % TAX^A/N^^^^2^A/N "DATA",9002313.91,115,5) HM^8^^^28 "DATA",9002313.91,115,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,115,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,115,25,0) ^^1^1^3031205^ "DATA",9002313.91,115,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,115,30,0) ^^1^1^3031205^ "DATA",9002313.91,115,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),340),U,9)=BPS("X") "DATA",9002313.91,116,0) 350^^PATIENT E-MAIL ADDRESS^A/N^^^^80^A/N "DATA",9002313.91,116,5) HN^80^^2 "DATA",9002313.91,116,10,0) ^9002313.9101^1^1^3030512 "DATA",9002313.91,116,10,1,0) S BPS("X")=$G(BPS("Patient","Patient E-Mail Address")) "DATA",9002313.91,116,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,116,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),80) "DATA",9002313.91,116,30,0) ^9002313.9103^1^1^3101101^^^ "DATA",9002313.91,116,30,1,0) S $P(^BPSC(BPS(9002313.02),340),U,10)=$G(BPS("X")) "DATA",9002313.91,117,0) 351^^OTHER PAYER-PAT RESP AMT QLFR^A/N^^^^2^A/N "DATA",9002313.91,117,1) OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT QUALIFIER "DATA",9002313.91,117,5) NP^1^^7 "DATA",9002313.91,117,10,0) ^^1^1^3101222^ "DATA",9002313.91,117,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,117,20,0) ^9002313.9102^1^1^3101220^ "DATA",9002313.91,117,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,117,30,0) ^^1^1^3101222^ "DATA",9002313.91,117,30,1,0) D SET351^BPSFLD01 "DATA",9002313.91,118,0) 352^^OTHER PAYER-PAT RESP AMOUNT^D^^^^10^D "DATA",9002313.91,118,1) OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT "DATA",9002313.91,118,5) NQ^10^^7 "DATA",9002313.91,118,10,0) ^^1^1^3101222^ "DATA",9002313.91,118,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,118,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,118,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,118,25,0) ^9002313.9104^1^1^3031212^ "DATA",9002313.91,118,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,118,30,0) ^9002313.9103^1^1^3101222^^ "DATA",9002313.91,118,30,1,0) D SET352^BPSFLD01 "DATA",9002313.91,119,0) 353^^OTHER PAYER-PAT RESP AMT CNT^N^^^^2^N "DATA",9002313.91,119,1) OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT COUNT "DATA",9002313.91,119,5) NR^1^^7 "DATA",9002313.91,119,10,0) ^^1^1^3101222^ "DATA",9002313.91,119,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,119,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,119,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,119,30,0) ^9002313.9103^1^1^3101222^^ "DATA",9002313.91,119,30,1,0) D SET353^BPSFLD01 "DATA",9002313.91,120,0) 445^^ORIG PRESCRIBED PROD/SERV CODE^A/N^^^^19^A/N "DATA",9002313.91,120,1) ORIGINALLY PRESCRIBED PRODUCT/SERVICE CODE "DATA",9002313.91,120,5) EA^19^^4 "DATA",9002313.91,120,10,0) ^9002313.9101^1^1^3101029^ "DATA",9002313.91,120,10,1,0) S BPS("X")="" "DATA",9002313.91,120,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,120,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19) "DATA",9002313.91,120,25,0) ^9002313.9104^1^1^3040107^^ "DATA",9002313.91,120,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),19) "DATA",9002313.91,120,30,0) ^9002313.9103^1^1^3101115^ "DATA",9002313.91,120,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),440),U,5)="" "DATA",9002313.91,121,0) 446^^ORIGINALLY PRESCRIBED QUANTITY^N^^^^10^N "DATA",9002313.91,121,5) EB^10^^4 "DATA",9002313.91,121,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,121,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Quantity"))*1000\1 "DATA",9002313.91,121,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,121,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,121,25,0) ^9002313.9104^1^1^3030828^^^^ "DATA",9002313.91,121,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,121,30,0) ^9002313.9103^1^1^3030828^^^^ "DATA",9002313.91,121,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),440),U,6)=BPS("X") ;VA "DATA",9002313.91,122,0) 454^^SCHEDULED PRESCRIPTION ID NUM^N^^^^12^A/N "DATA",9002313.91,122,1) SCHEDULED PRESCRIPTION ID NUMBER "DATA",9002313.91,122,5) EK^12^^4 "DATA",9002313.91,122,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,122,10,1,0) S BPS("X")="" "DATA",9002313.91,122,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,122,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12) "DATA",9002313.91,122,25,0) ^9002313.9104^1^1^3040224^^ "DATA",9002313.91,122,25,1,0) S BPS("X")=$$NFF^BPSECFM(BPS("X"),12) "DATA",9002313.91,122,30,0) ^9002313.9103^1^1^3040224^^ "DATA",9002313.91,122,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,4)=BPS("X") "DATA",9002313.91,123,0) 456^^ASSOC PRESCRIPTION/SERV REF NO^A/N^^^^12^N "DATA",9002313.91,123,1) ASSOCIATED PRESCRIPTION/ SERVICE REFERENCE NUMBER "DATA",9002313.91,123,5) EN^7^^4 "DATA",9002313.91,123,10,0) ^9002313.9101^1^1^3030823 "DATA",9002313.91,123,10,1,0) S BPS("X")="" "DATA",9002313.91,123,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,123,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),12) "DATA",9002313.91,123,25,0) ^9002313.9104^1^1^3030823^^ "DATA",9002313.91,123,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),7) "DATA",9002313.91,123,30,0) ^^1^1^3110720^ "DATA",9002313.91,123,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,6)=$S($G(BPS("NCPDP","Version"))=51:BPS("X"),1:"") "DATA",9002313.91,124,0) 457^^ASSOC PRESCRIPTION/SERV DATE^A/N^^^^8^N "DATA",9002313.91,124,1) ASSOCIATED PRESCRIPTION/ SERVICE DATE "DATA",9002313.91,124,5) EP^8^^4 "DATA",9002313.91,124,10,0) ^9002313.9101^1^1^3101029^ "DATA",9002313.91,124,10,1,0) S BPS("X")="" "DATA",9002313.91,124,20,0) ^9002313.9102^1^1^3101029^ "DATA",9002313.91,124,20,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,124,25,0) ^9002313.9104^1^1^3101029^ "DATA",9002313.91,124,25,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,124,30,0) ^9002313.9103^1^1^3110720^^ "DATA",9002313.91,124,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,7)=$S($G(BPS("NCPDP","Version"))=51:BPS("X"),1:"") "DATA",9002313.91,125,0) 458^^PROCEDURE MODIFIER CODE COUNT^N^^^^2^N "DATA",9002313.91,125,5) SE^1^^4 "DATA",9002313.91,125,10,0) ^9002313.9101^1^1^3040819 "DATA",9002313.91,125,10,1,0) S BPS("X")="" "DATA",9002313.91,125,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,125,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,125,25,0) ^9002313.9104^1^1^3040819^^^^ "DATA",9002313.91,125,25,1,0) S BPS("X")=$$NFF^BPSECFM(BPS("X"),1) "DATA",9002313.91,125,30,0) ^9002313.9103^1^1^3040819^ "DATA",9002313.91,125,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,8)="" "DATA",9002313.91,126,0) 459^^PROCEDURE MODIFIER CODE^A/N^^^^2^A/N "DATA",9002313.91,126,5) ER^2^^4 "DATA",9002313.91,126,10,0) ^9002313.9101^1^1^3040819 "DATA",9002313.91,126,10,1,0) S BPS("X")="" "DATA",9002313.91,126,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,126,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,126,25,0) ^9002313.9104^1^1^3040819^^^^ "DATA",9002313.91,126,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),2) "DATA",9002313.91,126,30,0) ^^1^1^3110727^ "DATA",9002313.91,126,30,1,0) ; Not implemented "DATA",9002313.91,127,0) 461^^PRIOR AUTHORIZATION TYPE CODE^N^^^^2^N "DATA",9002313.91,127,5) EU^2^^4 "DATA",9002313.91,127,10,0) ^9002313.9101^2^2^3101115^ "DATA",9002313.91,127,10,1,0) S BPS("X")=$G(BPS("Claim",BPS(9002313.0201),"Prior Auth Type")) "DATA",9002313.91,127,10,2,0) S:BPS("X")="" BPS("X")=0 "DATA",9002313.91,127,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,127,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,127,25,0) ^9002313.9104^1^1^3031222^^^^ "DATA",9002313.91,127,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,127,30,0) ^9002313.9103^1^1^3031222^^^^ "DATA",9002313.91,127,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,1)=BPS("X") "DATA",9002313.91,128,0) 462^^PRIOR AUTH NUMBER SUBMITTED^A/N^^^^11^N "DATA",9002313.91,128,1) PRIOR AUTHORIZATION NUMBER SUBMITTED "DATA",9002313.91,128,5) EV^11^^4 "DATA",9002313.91,128,10,0) ^9002313.9101^1^1^3031222 "DATA",9002313.91,128,10,1,0) S BPS("X")=$G(BPS("Claim",BPS(9002313.0201),"Prior Auth Num Sub")) "DATA",9002313.91,128,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,128,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),11) "DATA",9002313.91,128,25,0) ^9002313.9104^1^1^3031222^^^^ "DATA",9002313.91,128,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),11) "DATA",9002313.91,128,30,0) ^9002313.9103^1^1^3031222^^^^ "DATA",9002313.91,128,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,2)=BPS("X") "DATA",9002313.91,129,0) 464^^INTERMEDIARY AUTHORIZATION ID^A/N^^^^11^A/N "DATA",9002313.91,129,5) EX^11^^4 "DATA",9002313.91,129,10,0) ^^2^2^3110727^ "DATA",9002313.91,129,10,1,0) S BPS("X")=$G(BPS("Claim",BPS(9002313.0201),"Intermediary Auth ID")) "DATA",9002313.91,129,10,2,0) S:BPS("X")="" BPS("X")="" "DATA",9002313.91,129,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,129,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),11) "DATA",9002313.91,129,25,0) ^9002313.9104^1^1^3030823^ "DATA",9002313.91,129,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),11) "DATA",9002313.91,129,30,0) ^9002313.9103^1^1^3030823^^^ "DATA",9002313.91,129,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,4)=BPS("X") "DATA",9002313.91,130,0) 471^^OTHER PAYER REJECT COUNT^N^^^^2^N "DATA",9002313.91,130,5) 5E^2^^7 "DATA",9002313.91,130,10,0) ^9002313.9101^1^1^3100916 "DATA",9002313.91,130,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,130,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,130,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,130,25,0) ^9002313.9104^1^1^3040224^^ "DATA",9002313.91,130,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,130,30,0) ^9002313.9103^1^1^3100824 "DATA",9002313.91,130,30,1,0) D SET471^BPSFLD01 "DATA",9002313.91,131,0) 472^^OTHER PAYER REJECT CODE^A/N^^^^3^A/N "DATA",9002313.91,131,5) 6E^3^^7 "DATA",9002313.91,131,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,131,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,131,20,0) ^9002313.9102^1^1^3101206^ "DATA",9002313.91,131,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,131,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,131,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,131,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,131,30,1,0) D SET472^BPSFLD01 "DATA",9002313.91,132,0) 473^^DUR/PPS CODE COUNTER^N^^^^1^N "DATA",9002313.91,132,5) 7E^1^^9 "DATA",9002313.91,132,10,0) ^9002313.9101^1^1^3031230 "DATA",9002313.91,132,10,1,0) S BPS("X")=1 "DATA",9002313.91,132,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,132,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,132,25,0) ^9002313.9104^1^1^3031230^^^^ "DATA",9002313.91,132,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,132,30,0) ^9002313.9103^1^1^3031230^^^^ "DATA",9002313.91,132,30,1,0) D FLD473^BPSOSSG "DATA",9002313.91,133,0) 474^^DUR/PPS LEVEL OF EFFORT^N^^^^2^N "DATA",9002313.91,133,5) 8E^2^^9 "DATA",9002313.91,133,10,0) ^9002313.9101^1^1^3030718 "DATA",9002313.91,133,10,1,0) S BPS("X")=12 "DATA",9002313.91,133,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,133,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,133,25,0) ^9002313.9104^1^1^3030718^ "DATA",9002313.91,133,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,133,30,0) ^9002313.9103^1^1^3030718^ "DATA",9002313.91,133,30,1,0) D FLD474^BPSOSSG "DATA",9002313.91,134,0) 475^^DUR/DUE CO-AGENT ID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,134,5) J9^2^^9 "DATA",9002313.91,134,10,0) ^9002313.9101^1^1^3030718 "DATA",9002313.91,134,10,1,0) S BPS("X")="" "DATA",9002313.91,134,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,134,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,134,25,0) ^9002313.9104^1^1^3030718^ "DATA",9002313.91,134,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,134,30,0) ^9002313.9103^1^1^3030718^ "DATA",9002313.91,134,30,1,0) D FLD475^BPSOSSG "DATA",9002313.91,135,0) 476^^DUR/DUE CO-AGENT ID^A/N^^^^19^A/N "DATA",9002313.91,135,5) H6^19^^9 "DATA",9002313.91,135,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,135,10,1,0) S BPS("X")="" "DATA",9002313.91,135,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,135,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19) "DATA",9002313.91,135,25,0) ^9002313.9104^1^1^3040107^^^ "DATA",9002313.91,135,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19) "DATA",9002313.91,135,30,0) ^9002313.9103^1^1^3101115^^^^ "DATA",9002313.91,135,30,1,0) D FLD476^BPSOSSG "DATA",9002313.91,136,0) 477^^PROF SERVICE FEE SUBMITTED^D^^^^8^D "DATA",9002313.91,136,1) PROFESSIONAL SERVICE FEE SUBMITTED "DATA",9002313.91,136,5) BE^8^^10 "DATA",9002313.91,136,10,0) ^9002313.9101^1^1^3100916 "DATA",9002313.91,136,10,1,0) S BPS("X")=0 "DATA",9002313.91,136,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,136,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,136,25,0) ^9002313.9104^1^1^3101029^ "DATA",9002313.91,136,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,136,30,0) ^9002313.9103^1^1^3030823^^ "DATA",9002313.91,136,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),470),U,7)=BPS("X") "DATA",9002313.91,139,0) 481^^REGULATORY FEE AMT SUBMITTED^D^^^^8^D "DATA",9002313.91,139,1) REGULATORY FEE AMOUNT SUBMITTED "DATA",9002313.91,139,5) HA^8^^10 "DATA",9002313.91,139,10,0) ^9002313.9101^1^1^3100916 "DATA",9002313.91,139,10,1,0) S BPS("X")=0 "DATA",9002313.91,139,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,139,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,139,25,0) ^9002313.9104^1^1^3040907^^ "DATA",9002313.91,139,25,1,0) S BPS("X")=$$DFF^BPSECFM(BPS("X"),8) "DATA",9002313.91,139,30,0) ^9002313.9103^1^1^3100923^^^^ "DATA",9002313.91,139,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,1)=$S($G(BPS("NCPDP","Version"))=51:BPS("X"),1:"") "DATA",9002313.91,140,0) 482^^PERCENT TAX AMT SUBMITTED^D^^^^8^D "DATA",9002313.91,140,1) PERCENT TAX AMOUNT SUBMITTED "DATA",9002313.91,140,5) GE^8^^10 "DATA",9002313.91,140,10,0) ^9002313.9101^1^1^3050802 "DATA",9002313.91,140,10,1,0) S BPS("X")=0 "DATA",9002313.91,140,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,140,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,140,25,0) ^9002313.9104^1^1^3040907^^^^ "DATA",9002313.91,140,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,140,30,0) ^9002313.9103^1^1^3100923^^^^ "DATA",9002313.91,140,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,2)=$S($G(BPS("NCPDP","Version"))=51:BPS("X"),1:"") "DATA",9002313.91,141,0) 483^^PERCENT TAX RATE SUBMITTED^D^^^^7^D "DATA",9002313.91,141,1) PERCENTAGE SALES TAX RATE SUBMITTED "DATA",9002313.91,141,5) HE^7^^10 "DATA",9002313.91,141,10,0) ^9002313.9101^1^1^3101029^ "DATA",9002313.91,141,10,1,0) S BPS("X")=+$G(BPS("Insurer","Percent Sales Tax Rate Sub")) "DATA",9002313.91,141,20,0) ^^1^1^3121128 "DATA",9002313.91,141,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),7,4) "DATA",9002313.91,141,25,0) ^^1^1^3121128 "DATA",9002313.91,141,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),7,4) "DATA",9002313.91,141,30,0) ^9002313.9103^1^1^3100923^^^^ "DATA",9002313.91,141,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,3)=$S($G(BPS("NCPDP","Version"))=51:BPS("X"),1:"") "DATA",9002313.91,142,0) 484^^PERCENTAGE TAX BASIS SBMTTD^A/N^^^^2^A/N "DATA",9002313.91,142,1) PERCENTAGE SALES TAX BASIS SUBMITTED "DATA",9002313.91,142,5) JE^2^^10 "DATA",9002313.91,142,10,0) ^9002313.9101^1^1^3050802 "DATA",9002313.91,142,10,1,0) S BPS("X")="" "DATA",9002313.91,142,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,142,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,142,25,0) ^9002313.9104^1^1^3030824^ "DATA",9002313.91,142,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),2) "DATA",9002313.91,142,30,0) ^9002313.9103^1^1^3100923^^^^ "DATA",9002313.91,142,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,4)=$S($G(BPS("NCPDP","Version"))=51:BPS("X"),1:"") "DATA",9002313.91,143,0) 485^^COUPON TYPE^A/N^^^^2^A/N "DATA",9002313.91,143,5) KE^2^^11 "DATA",9002313.91,143,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,143,10,1,0) S BPS("X")="" "DATA",9002313.91,143,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,143,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,143,25,0) ^9002313.9104^1^1^3040107^^ "DATA",9002313.91,143,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,143,30,0) ^9002313.9103^1^1^3101115^^^ "DATA",9002313.91,143,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,5)=BPS("X") "DATA",9002313.91,144,0) 486^^COUPON NUMBER^A/N^^^^15^A/N "DATA",9002313.91,144,5) ME^15^^11 "DATA",9002313.91,144,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,144,10,1,0) S BPS("X")="" "DATA",9002313.91,144,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,144,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,144,25,0) ^9002313.9104^1^1^3031210^^ "DATA",9002313.91,144,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,144,30,0) ^9002313.9103^1^1^3031210^^ "DATA",9002313.91,144,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,6)=BPS("X") "DATA",9002313.91,145,0) 487^^COUPON VALUE AMOUNT^D^^^^8^D "DATA",9002313.91,145,5) NE^8^^11 "DATA",9002313.91,145,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,145,10,1,0) S BPS("X")="" "DATA",9002313.91,145,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,145,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,145,25,0) ^9002313.9104^1^1^3031210^^ "DATA",9002313.91,145,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,145,30,0) ^9002313.9103^1^1^3031210^^ "DATA",9002313.91,145,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,7)=BPS("X") "DATA",9002313.91,146,0) 491^^DIAGNOSIS CODE COUNT^N^^^^1^N "DATA",9002313.91,146,5) VE^1^^14 "DATA",9002313.91,146,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,146,10,1,0) S BPS("X")="" "DATA",9002313.91,146,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,146,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,146,25,0) ^9002313.9104^1^1^3040107^^^^ "DATA",9002313.91,146,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,147,0) 492^^DIAGNOSIS CODE QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,147,5) WE^2^^14 "DATA",9002313.91,147,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,147,10,1,0) S BPS("X")="" "DATA",9002313.91,147,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,147,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,147,25,0) ^9002313.9104^1^1^3040224^^^ "DATA",9002313.91,147,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,148,0) 493^^CLINICAL INFORMATION COUNTER^N^^^^1^N "DATA",9002313.91,148,5) XE^1^^14 "DATA",9002313.91,148,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,148,10,1,0) S BPS("X")="" "DATA",9002313.91,148,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,148,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,148,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,148,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,149,0) 498.01^^REQUEST TYPE^N^^^^1^A/N "DATA",9002313.91,149,5) PA^1^^13 "DATA",9002313.91,149,10,0) ^9002313.9101^1^1^3040428 "DATA",9002313.91,149,10,1,0) S BPS("X")="" "DATA",9002313.91,149,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,149,20,1,0) S BPS("X")="" "DATA",9002313.91,149,25,0) ^9002313.9104^1^1^3040428^ "DATA",9002313.91,149,25,1,0) S BPS("X")="" "DATA",9002313.91,150,0) 498.02^^REQUEST PERIOD DATE-BEGIN^A/N^^^^8^N "DATA",9002313.91,150,5) PB^8^^13 "DATA",9002313.91,150,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,150,10,1,0) S BPS("X")="" "DATA",9002313.91,150,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,150,20,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,151,0) 498.03^^REQUEST PERIOD DATE-END^A/N^^^^8^N "DATA",9002313.91,151,5) PC^8^^13 "DATA",9002313.91,151,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,151,10,1,0) S BPS("X")="" "DATA",9002313.91,151,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,151,20,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,152,0) 498.04^^BASIS OF REQUEST^A/N^^^^2^A/N "DATA",9002313.91,152,5) PD^2^^13 "DATA",9002313.91,152,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,152,10,1,0) S BPS("X")="" "DATA",9002313.91,152,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,152,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,153,0) 498.05^^AUTHORIZED REP FIRST NAME^A/N^^^^12^A/N "DATA",9002313.91,153,5) PE^12^^13 "DATA",9002313.91,153,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,153,10,1,0) S BPS("X")="" "DATA",9002313.91,153,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,153,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12) "DATA",9002313.91,154,0) 498.06^^AUTHORIZED REP LAST NAME^A/N^^^^15^A/N "DATA",9002313.91,154,5) PF^15^^13 "DATA",9002313.91,154,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,154,10,1,0) S BPS("X")="" "DATA",9002313.91,154,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,154,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,155,0) 498.07^^AUTHORIZED REP STREET ADDRESS^A/N^^^^30^A/N "DATA",9002313.91,155,5) PG^30^^13 "DATA",9002313.91,155,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,155,10,1,0) S BPS("X")="" "DATA",9002313.91,155,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,155,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,156,0) 498.08^^AUTH REP CITY ADDRESS^A/N^^^^20^A/N "DATA",9002313.91,156,5) PH^20^^13 "DATA",9002313.91,156,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,156,10,1,0) S BPS("X")="" "DATA",9002313.91,156,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,156,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,157,0) 498.09^^AUTHORIZED REP STATE/PROV ADDR^A/N^^^^2^A/N "DATA",9002313.91,157,5) PJ^2^^13 "DATA",9002313.91,157,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,157,10,1,0) S BPS("X")="" "DATA",9002313.91,157,20,0) ^9002313.9102^1^1^3101206^ "DATA",9002313.91,157,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,158,0) 498.11^^AUTHORIZED REP ZIP/POSTAL ZONE^A/N^^^^15^A/N "DATA",9002313.91,158,1) AUTHORIZED REPRESENTATIVE ZIP/POSTAL ZONE "DATA",9002313.91,158,5) PK^15^^13 "DATA",9002313.91,158,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,158,10,1,0) S BPS("X")="" "DATA",9002313.91,158,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,158,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,159,0) 498.12^^PRESCRIBER TELEPHONE NUMBER^N^^^^10^N "DATA",9002313.91,159,5) PM^10^^6 "DATA",9002313.91,159,10,0) ^9002313.9101^1^1^3050802 "DATA",9002313.91,159,10,1,0) S BPS("X")=$TR($G(BPS("RX",BPS(9002313.0201),"Prescriber Phone #")),"#() -_*.@") "DATA",9002313.91,159,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,159,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,159,25,0) ^9002313.9104^1^1^3030722^^ "DATA",9002313.91,159,25,1,0) S BPS("X")=$$NFF^BPSECFM(BPS("X"),10) "DATA",9002313.91,159,30,0) ^9002313.9103^1^1^3030722^^ "DATA",9002313.91,159,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),498),U,12)=BPS("X") "DATA",9002313.91,160,0) 498.13^^PRIOR AUTH SUPPORTING DOCUMENT^A/N^^^^500^A/N "DATA",9002313.91,160,5) PP^200^^13 "DATA",9002313.91,160,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,160,10,1,0) S BPS("X")="" "DATA",9002313.91,160,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,160,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),500) "DATA",9002313.91,161,0) 498.14^^PRIOR AUTH NUMBER-ASSIGNED^N^^^^11^N "DATA",9002313.91,161,5) PY^8^^^30 "DATA",9002313.91,161,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,161,10,1,0) S BPS("X")="" "DATA",9002313.91,161,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,161,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),11) "DATA",9002313.91,162,0) 498.52^^PRIOR AUTH EFFECTIVE DATE^A/N^^^^8^N "DATA",9002313.91,162,5) PS^8^^^30 "DATA",9002313.91,162,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,162,10,1,0) S BPS("X")="" "DATA",9002313.91,162,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,162,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,163,0) 498.53^^PRIOR AUTH EXPIRATION DATE^A/N^^^^8^N "DATA",9002313.91,163,5) PT^8^^^30 "DATA",9002313.91,163,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,163,10,1,0) S BPS("X")="" "DATA",9002313.91,163,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,163,20,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,164,0) 498.54^^PRIOR AUTH NO REFILLS AUTH^N^^^^2^N "DATA",9002313.91,164,5) PW^8^^^30 "DATA",9002313.91,164,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,164,10,1,0) S BPS("X")="" "DATA",9002313.91,164,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,164,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,165,0) 498.55^^PRIOR AUTH QTY ACCUMULATED^N^^^^10^N "DATA",9002313.91,165,5) PX^8^^^30 "DATA",9002313.91,165,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,165,10,1,0) S BPS("X")="" "DATA",9002313.91,165,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,165,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,166,0) 498.57^^PRIOR AUTHORIZATION QUANTITY^A/N^^^^10^N "DATA",9002313.91,166,5) RA^3^^^30 "DATA",9002313.91,166,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,166,10,1,0) S BPS("X")="" "DATA",9002313.91,166,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,166,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,167,0) 498.58^^PRIOR AUTH DOLLARS AUTHORIZED^N^^^^8^D "DATA",9002313.91,167,5) RB^8^^^30 "DATA",9002313.91,167,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,167,10,1,0) S BPS("X")="" "DATA",9002313.91,167,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,167,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,168,0) 498.59^^AUTH REP CITY ADDRESS^A/N^^^^20^A/N "DATA",9002313.91,168,5) PH^20^^13 "DATA",9002313.91,168,10,0) ^9002313.9101^1^1^3030512 "DATA",9002313.91,168,10,1,0) S BPS("X")="" "DATA",9002313.91,168,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,168,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,169,0) 501^^HEADER RESPONSE STATUS^A/N^^^^1^A/N "DATA",9002313.91,169,5) F1^1^^^22 "DATA",9002313.91,169,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,169,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,169,25,0) ^9002313.9104^1^1^3040202^^^ "DATA",9002313.91,169,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,169,30,0) ^9002313.9103^1^1^3040202^^^ "DATA",9002313.91,169,30,1,0) S $P(^BPSR(BPS(9002313.02),500),U,1)=BPS("X") "DATA",9002313.91,170,0) 503^^AUTHORIZATION NUMBER^A/N^^^^20^A/N "DATA",9002313.91,170,5) F3^20^^^26 "DATA",9002313.91,170,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,170,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,170,30,0) ^^1^1^3031205^ "DATA",9002313.91,170,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,3)=BPS("X") "DATA",9002313.91,171,0) 504^^MESSAGE^A/N^^^^200^A/N "DATA",9002313.91,171,5) F4^200^^^23 "DATA",9002313.91,171,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,171,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,171,25,0) ^^1^1^3031211^ "DATA",9002313.91,171,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),200) "DATA",9002313.91,171,30,0) ^^1^1^3031211^ "DATA",9002313.91,171,30,1,0) S $P(^BPSR(BPS(9002313.02),504),U,1)=BPS("X") "DATA",9002313.91,172,0) 505^^PATIENT PAY AMOUNT^A/N^^^^8^D "DATA",9002313.91,172,5) F5^8^^^28 "DATA",9002313.91,172,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,172,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,172,25,0) ^9002313.9104^1^1^3031212^^ "DATA",9002313.91,172,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,172,30,0) ^9002313.9103^1^1^3031212^^ "DATA",9002313.91,172,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,5)=S BPS("X") "DATA",9002313.91,173,0) 506^^INGREDIENT COST PAID^A/N^^^^8^D "DATA",9002313.91,173,5) F6^8^^^28 "DATA",9002313.91,173,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,173,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,173,25,0) ^9002313.9104^1^1^3031211^^ "DATA",9002313.91,173,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,173,30,0) ^9002313.9103^1^1^3031211^^ "DATA",9002313.91,173,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,6)=BPS("X") "DATA",9002313.91,174,0) 507^^DISPENSING FEE PAID^A/N^^^^8^D "DATA",9002313.91,174,5) F7^8^^^28 "DATA",9002313.91,174,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,174,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,174,25,0) ^9002313.9104^1^1^3031210^^^ "DATA",9002313.91,174,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,174,30,0) ^9002313.9103^1^1^3031210^^^ "DATA",9002313.91,174,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,7)=BPS("X") "DATA",9002313.91,175,0) 509^^TOTAL AMOUNT PAID^A/N^^^^8^D "DATA",9002313.91,175,5) F9^8^^^28 "DATA",9002313.91,175,10,0) ^9002313.9101^1^1^3101115^^ "DATA",9002313.91,175,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,175,25,0) ^9002313.9104^1^1^3031217^^ "DATA",9002313.91,175,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,175,30,0) ^9002313.9103^1^1^3031217^^ "DATA",9002313.91,175,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,9) "DATA",9002313.91,176,0) 510^^REJECT COUNT^N^^^^2^N "DATA",9002313.91,176,5) FA^2^^^26 "DATA",9002313.91,176,10,0) ^9002313.9101^1^1^3101115^^ "DATA",9002313.91,176,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,176,25,0) ^^1^1^3031217^ "DATA",9002313.91,176,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,176,30,0) ^^1^1^3031217^ "DATA",9002313.91,176,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,10)=BPS("X") "DATA",9002313.91,177,0) 511^^REJECT CODE^A/N^^^^3^A/N "DATA",9002313.91,177,5) FB^3^^^26 "DATA",9002313.91,177,10,0) ^9002313.9101^1^1^3101115^^ "DATA",9002313.91,177,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,177,25,0) ^9002313.9104^1^1^3031217^^ "DATA",9002313.91,177,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,177,30,0) ^9002313.9103^1^1^3031217^^ "DATA",9002313.91,177,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),511,DUR,0),U,1) "DATA",9002313.91,178,0) 512^^ACCUMULATED DEDUCTIBLE AMOUNT^A/N^^^^8^D "DATA",9002313.91,178,5) FC^8^^^28 "DATA",9002313.91,178,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,178,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,178,25,0) ^9002313.9104^1^1^3031210^^^^ "DATA",9002313.91,178,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,178,30,0) ^9002313.9103^1^1^3031210^^^^ "DATA",9002313.91,178,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),"^",10)=BPS("X") "DATA",9002313.91,179,0) 513^^REMAINING DEDUCTIBLE AMOUNT^A/N^^^^8^D "DATA",9002313.91,179,5) FD^8^^^28 "DATA",9002313.91,179,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,179,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,179,25,0) ^9002313.9104^1^1^3031217^^ "DATA",9002313.91,179,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,179,30,0) ^9002313.9103^1^1^3031217^^ "DATA",9002313.91,179,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,13)=BPS("X") "DATA",9002313.91,180,0) 514^^REMAINING BENEFIT AMOUNT^A/N^^^^8^D "DATA",9002313.91,180,5) FE^8^^^28 "DATA",9002313.91,180,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,180,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,180,25,0) ^9002313.9104^1^1^3031217^^^ "DATA",9002313.91,180,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,180,30,0) ^9002313.9103^1^1^3031217^^^ "DATA",9002313.91,180,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,14) "DATA",9002313.91,182,0) 517^^AMT APPLIED TO PERIODIC DEDUCT^D^^^^8^D "DATA",9002313.91,182,5) FH^8^^^28 "DATA",9002313.91,182,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,182,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,182,25,0) ^9002313.9104^1^1^3031205^^^ "DATA",9002313.91,182,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,182,30,0) ^9002313.9103^1^1^3031205^^ "DATA",9002313.91,182,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),"^",17)=BPS("X") "DATA",9002313.91,183,0) 518^^AMOUNT OF COPAY^D^^^^8^D "DATA",9002313.91,183,5) FI^8^^^28 "DATA",9002313.91,183,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,183,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,183,25,0) ^^1^1^3031205^ "DATA",9002313.91,183,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,183,30,0) ^^1^1^3031205^ "DATA",9002313.91,183,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),"^",18)=BPS("X") "DATA",9002313.91,184,0) 519^^AMT ATTRIBUTED TO PRODUCT SEL^D^^^^8^D "DATA",9002313.91,184,5) FJ^8 "DATA",9002313.91,184,10,0) ^^3^3^3211228^ "DATA",9002313.91,184,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,184,10,2,0) ; Field 519-FJ was added to file 9002313.91 in error. It should never "DATA",9002313.91,184,10,3,0) ; be populated. "DATA",9002313.91,184,25,0) ^^1^1^3031205^ "DATA",9002313.91,184,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,184,30,0) ^^1^1^3031205^ "DATA",9002313.91,184,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,19)=BPS("X") "DATA",9002313.91,185,0) 520^^AMOUNT EXCEEDING PERIODIC MAX^D^^^^8^D "DATA",9002313.91,185,5) FK^8^^^28 "DATA",9002313.91,185,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,185,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,185,25,0) ^^1^1^3031205^ "DATA",9002313.91,185,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,185,30,0) ^^1^1^3031205^ "DATA",9002313.91,185,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,20)=BPS("X") "DATA",9002313.91,186,0) 521^^INCENTIVE AMOUNT PAID^A/N^^^^8^D "DATA",9002313.91,186,5) FL^8^^^28 "DATA",9002313.91,186,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,186,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,186,25,0) ^^1^1^3031210^ "DATA",9002313.91,186,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,186,30,0) ^^1^1^3031210^ "DATA",9002313.91,186,30,1,0) $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,21)=BPS("X") "DATA",9002313.91,187,0) 522^^BASIS OF REIMB DETERMINATION^N^^^^2^N "DATA",9002313.91,187,5) FM^2^^^28 "DATA",9002313.91,187,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,187,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,187,25,0) ^^1^1^3031205^ "DATA",9002313.91,187,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,187,30,0) ^^1^1^3031205^ "DATA",9002313.91,187,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,22)=BPS("X") "DATA",9002313.91,188,0) 523^^AMOUNT ATTRIBUTED TO SALES TAX^D^^^^8^D "DATA",9002313.91,188,5) FN^8^^^28 "DATA",9002313.91,188,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,188,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,188,25,0) ^^1^1^3031205^ "DATA",9002313.91,188,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,188,30,0) ^^1^1^3031205^ "DATA",9002313.91,188,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),"^",23)=BPS("X") "DATA",9002313.91,189,0) 524^^PLAN ID^A/N^^^^8^A/N "DATA",9002313.91,189,5) FO^8^^3^24 "DATA",9002313.91,189,10,0) ^^1^1^3110301^ "DATA",9002313.91,189,10,1,0) S BPS("X")=$G(BPS("Insurer","Plan ID")) "DATA",9002313.91,189,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,189,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,189,25,0) ^9002313.9104^1^1^3061122^ "DATA",9002313.91,189,25,1,0) S BPS("X")=$$ANFF^BPSECFM(BPS("X"),8) "DATA",9002313.91,189,30,0) ^9002313.9103^1^1^3030825^^^^ "DATA",9002313.91,189,30,1,0) S $P(^BPSC(BPS(9002313.02),520),U,4)=BPS("X") "DATA",9002313.91,191,0) 526^^ADDITIONAL MESSAGE INFORMATION^A/N^^^^40^A/N "DATA",9002313.91,191,5) FQ^200^^^26 "DATA",9002313.91,191,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,191,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,191,25,0) ^9002313.9104^1^1^3031210^^^^ "DATA",9002313.91,191,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),200) "DATA",9002313.91,191,30,0) ^9002313.9103^1^1^3031210^^^^ "DATA",9002313.91,191,30,1,0) S ^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),526)=BPS("X") "DATA",9002313.91,192,0) 528^^CLINICAL SIGNIFICANCE CODE^A/N^^^^1^A/N "DATA",9002313.91,192,5) FS^1^^^29 "DATA",9002313.91,192,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,192,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,192,25,0) ^9002313.9104^1^1^3031210^^^^ "DATA",9002313.91,192,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,192,30,0) ^9002313.9103^1^1^3180807^^^^ "DATA",9002313.91,192,30,1,0) S ^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),525)=$G(BPS("X")) "DATA",9002313.91,193,0) 529^^OTHER PHARMACY INDICATOR^A/N^^^^1^N "DATA",9002313.91,193,5) FT^1^^^29 "DATA",9002313.91,193,10,0) ^9002313.9101^1^1^3031212 "DATA",9002313.91,193,10,1,0) S BPS("X")="" "DATA",9002313.91,193,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,193,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,194,0) 530^^PREVIOUS DATE OF SERVICE^A/N^^^^8^N "DATA",9002313.91,194,5) FU^8^^^29 "DATA",9002313.91,194,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,194,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,194,25,0) ^^1^1^3031216^ "DATA",9002313.91,194,25,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X")) "DATA",9002313.91,194,30,0) ^^1^1^3031216^ "DATA",9002313.91,194,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),567.01,DUR,0),U,5)=BPS("X") "DATA",9002313.91,195,0) 531^^QTY OF PREVIOUS DISPENSING^N^^^^10^N "DATA",9002313.91,195,5) FV^8^^^29 "DATA",9002313.91,195,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,195,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,195,25,0) ^9002313.9104^1^1^3031217^^ "DATA",9002313.91,195,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,195,30,0) ^9002313.9103^1^1^3031217^^ "DATA",9002313.91,195,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),567.01,DUR,0),U,6)=BPS("X") "DATA",9002313.91,196,0) 532^^DATABASE INDICATOR^A/N^^^^1^A/N "DATA",9002313.91,196,5) FW^1^^^29 "DATA",9002313.91,196,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,196,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,196,25,0) ^9002313.9104^1^1^3031210^^^ "DATA",9002313.91,196,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,196,30,0) ^9002313.9103^1^1^3031210^^^ "DATA",9002313.91,196,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),567.01,BPS(9002313.020101),0),U,7)=BPS("X") "DATA",9002313.91,197,0) 533^^OTHER PRESCRIBER INDICATOR^A/N^^^^1^N "DATA",9002313.91,197,5) FX^1^^^29 "DATA",9002313.91,197,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,197,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,197,25,0) ^^1^1^3031212^ "DATA",9002313.91,197,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,197,30,0) ^^1^1^3031212^ "DATA",9002313.91,197,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),567.01,DUR,0),U,8)=BPS("X") "DATA",9002313.91,199,0) 544^^DUR/DUE FREE TEXT MESSAGE^A/N^^^^30^A/N "DATA",9002313.91,199,5) FY^30^^^29 "DATA",9002313.91,199,10,0) ^9002313.9101^1^1^3101116^ "DATA",9002313.91,199,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,199,25,0) ^9002313.9104^1^1^3031210^^ "DATA",9002313.91,199,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,199,30,0) ^9002313.9103^1^1^3031210^^ "DATA",9002313.91,199,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),567.01,DUR,0),U,9)=BPS("X") "DATA",9002313.91,200,0) 545^^NETWORK REIMBURSEMENT ID^A/N^^^^10^A/N "DATA",9002313.91,200,5) 2F^10^^^24 "DATA",9002313.91,200,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,200,10,1,0) S BPS("X")="" "DATA",9002313.91,200,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,200,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,201,0) 546^^REJECT FIELD OCCURRENCE INDCTR^A/N^^^^2^N "DATA",9002313.91,201,1) REJECT FIELD OCCURRENCE INDICATOR "DATA",9002313.91,201,5) 4F^2^^^26 "DATA",9002313.91,201,10,0) ^9002313.9101^1^1^3191009^^ "DATA",9002313.91,201,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,201,25,0) ^9002313.9104^1^1^3191009^^^ "DATA",9002313.91,201,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,201,30,0) ^9002313.9103^1^1^3191009^^^ "DATA",9002313.91,201,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),511,DUR,0),U,2)=BPS("X") "DATA",9002313.91,202,0) 547^^APPROVED MESSAGE CODE COUNT^A/N^^^^1^N "DATA",9002313.91,202,5) 5F^1^^^26 "DATA",9002313.91,202,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,202,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,202,25,0) ^^1^1^3031205^ "DATA",9002313.91,202,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,202,30,0) ^^1^1^3031205^ "DATA",9002313.91,202,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),540),U,7)=BPS("X") "DATA",9002313.91,203,0) 548^^APPROVED MESSAGE CODE^A/N^^^^3^A/N "DATA",9002313.91,203,5) 6F^3^^^26 "DATA",9002313.91,203,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,203,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,203,25,0) ^9002313.9104^1^1^3031210^^^ "DATA",9002313.91,203,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,203,30,0) ^9002313.9103^1^1^3031210^^^ "DATA",9002313.91,203,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),548,0),B,4)=BPS("X") "DATA",9002313.91,204,0) 549^^HELP DESK PHONE NUMBER QUAL^A/N^^^^2^A/N "DATA",9002313.91,204,1) HELP DESK TELEPHONE NUMBER QUALIFER "DATA",9002313.91,204,5) 7F^2^^^26 "DATA",9002313.91,204,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,204,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,204,25,0) ^^1^1^3031210^ "DATA",9002313.91,204,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,204,30,0) ^^1^1^3031210^ "DATA",9002313.91,204,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),540),U,9)=BPS("X") "DATA",9002313.91,205,0) 550^^HELP DESK TELEPHONE NUMBER^A/N^^^^18^A/N "DATA",9002313.91,205,5) 8F^18^^^26 "DATA",9002313.91,205,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,205,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,205,25,0) ^9002313.9104^1^1^3031210^^ "DATA",9002313.91,205,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),18) "DATA",9002313.91,205,30,0) ^9002313.9103^1^1^3031210^^ "DATA",9002313.91,205,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),540),U,10)=BPS("X") "DATA",9002313.91,206,0) 551^^FORMULARY ALT PRODUCT COUNT^A/N^^^^1^N "DATA",9002313.91,206,5) 9F^1^^^27 "DATA",9002313.91,206,10,0) ^9002313.9101^1^1^3171117^ "DATA",9002313.91,206,10,1,0) S BPS("X")="" "DATA",9002313.91,206,20,0) ^9002313.9102^1^1^3171117^ "DATA",9002313.91,206,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,207,0) 552^^FORMULARY ALT ID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,207,5) AP^2^^^27 "DATA",9002313.91,207,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,207,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,207,25,0) ^^1^1^3031216^ "DATA",9002313.91,207,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,207,30,0) ^^1^1^3031216^ "DATA",9002313.91,207,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),551.01,DUR,1),U,1)=BPS("X") "DATA",9002313.91,208,0) 553^^FORMULARY ALTERNATIVE ID^A/N^^^^19^A/N "DATA",9002313.91,208,5) AR^19^^^27 "DATA",9002313.91,208,10,0) ^9002313.9101^1^1^3171117^^^ "DATA",9002313.91,208,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,208,25,0) ^9002313.9104^1^1^3171117^^ "DATA",9002313.91,208,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19) "DATA",9002313.91,208,30,0) ^9002313.9103^1^1^3171117^^ "DATA",9002313.91,208,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),551.01,DUR,1),U,2)=BPS("X") "DATA",9002313.91,209,0) 554^^FORMULARY ALT INCENTIVE^A/N^^^^8^D "DATA",9002313.91,209,5) AS^8^^^27 "DATA",9002313.91,209,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,209,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,209,25,0) ^^1^1^3031216^ "DATA",9002313.91,209,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,209,30,0) ^^1^1^3031216^ "DATA",9002313.91,209,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),551.01,DUR,1),U,3)=BPS("X") "DATA",9002313.91,210,0) 555^^FRMULRY ALT ESTMTD PT COST SHR^A/N^^^^8^D "DATA",9002313.91,210,5) AT^8^^^27 "DATA",9002313.91,210,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,210,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,210,25,0) ^9002313.9104^1^1^3031216^^ "DATA",9002313.91,210,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,210,30,0) ^9002313.9103^1^1^3031216^^ "DATA",9002313.91,210,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),551.01,DUR,1),U,4)=BPS("X") "DATA",9002313.91,211,0) 556^^FORMULARY ALT DESCRIPTION^A/N^^^^40^A/N "DATA",9002313.91,211,5) AU^40^^^27 "DATA",9002313.91,211,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,211,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,211,25,0) ^^1^1^3031216^ "DATA",9002313.91,211,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,211,30,0) ^^1^1^3031216^ "DATA",9002313.91,211,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),551.01,DUR,1),U,5)=BPS("X") "DATA",9002313.91,212,0) 557^^PERCENT TAX EXEMPT INDICATOR^A/N^^^^1^A/N "DATA",9002313.91,212,1) PERCENTAGE TAX EXEMPT INDICATOR "DATA",9002313.91,212,5) AV^1^^^28 "DATA",9002313.91,212,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,212,10,1,0) ;This is Response-only field which does not use the GET FORMAT or SET code "DATA",9002313.91,212,25,0) ^^1^1^3031217^ "DATA",9002313.91,212,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,212,30,0) ^^1^1^3031217^ "DATA",9002313.91,212,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),550),U,7) "DATA",9002313.91,213,0) 558^^REGULATORY FEE AMOUNT PAID^A/N^^^^8^D "DATA",9002313.91,213,5) AW^8^^^28 "DATA",9002313.91,213,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,213,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,213,25,0) ^9002313.9104^1^1^3031210^^ "DATA",9002313.91,213,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,213,30,0) ^9002313.9103^1^1^3031210^^ "DATA",9002313.91,213,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),550),U,8)=BPS("X") "DATA",9002313.91,214,0) 559^^PERCENTAGE TAX AMOUNT PAID^A/N^^^^8^D "DATA",9002313.91,214,5) AX^8^^^28 "DATA",9002313.91,214,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,214,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,214,25,0) ^9002313.9104^1^1^3031212^^ "DATA",9002313.91,214,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,214,30,0) ^9002313.9103^1^1^3031212^^^ "DATA",9002313.91,214,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),550),U,9)=BPS("X") "DATA",9002313.91,215,0) 560^^PERCENTAGE TAX RATE PAID^A/N^^^^7^D "DATA",9002313.91,215,5) AY^8^^^28 "DATA",9002313.91,215,10,0) ^9002313.9101^1^1^3040223 "DATA",9002313.91,215,10,1,0) S BPS("X")="" "DATA",9002313.91,215,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,215,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),7) "DATA",9002313.91,216,0) 561^^PERCENTAGE TAX BASIS PAID^A/N^^^^2^A/N "DATA",9002313.91,216,5) AZ^8^^^28 "DATA",9002313.91,216,10,0) ^9002313.9101^1^1^3031212 "DATA",9002313.91,216,10,1,0) S BPS("X")="" "DATA",9002313.91,216,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,216,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,217,0) 562^^PROFESSIONAL SERVICE FEE PAID^A/N^^^^8^D "DATA",9002313.91,217,5) J1^8^^^28 "DATA",9002313.91,217,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,217,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,217,25,0) ^^1^1^3031217^ "DATA",9002313.91,217,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,217,30,0) ^^1^1^3031217^ "DATA",9002313.91,217,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),560),U,2)=BPS("X") "DATA",9002313.91,218,0) 563^^OTHER AMOUNT PAID COUNT^N^^^^1^N "DATA",9002313.91,218,5) J2^1^^^28 "DATA",9002313.91,218,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,218,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,218,25,0) ^^1^1^3031212^ "DATA",9002313.91,218,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,218,30,0) ^^1^1^3031212^ "DATA",9002313.91,218,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),563.01,DUR,0)),U,1) "DATA",9002313.91,219,0) 564^^OTHER AMOUNT PAID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,219,5) J3^2^^^28 "DATA",9002313.91,219,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,219,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,219,25,0) ^^1^1^3031212^ "DATA",9002313.91,219,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,219,30,0) ^^1^1^3031212^ "DATA",9002313.91,219,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),563.01,DUR,1),U,1)=BPS("X") "DATA",9002313.91,220,0) 565^^OTHER AMOUNT PAID^A/N^^^^8^D "DATA",9002313.91,220,5) J4^8^^^28 "DATA",9002313.91,220,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,220,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,220,25,0) ^9002313.9104^1^1^3031212^^ "DATA",9002313.91,220,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,220,30,0) ^9002313.9103^1^1^3031212^^ "DATA",9002313.91,220,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),563.01,DUR,1),U,2)=BPS("X") "DATA",9002313.91,221,0) 566^^OTHER PAYER AMOUNT RECOGNIZED^A/N^^^^8^D "DATA",9002313.91,221,5) J5^8^^^28 "DATA",9002313.91,221,10,0) ^9002313.9101^1^1^3101115^^ "DATA",9002313.91,221,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,221,25,0) ^^1^1^3090304^ "DATA",9002313.91,221,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),6) "DATA",9002313.91,221,30,0) ^^1^1^3090304^ "DATA",9002313.91,221,30,1,0) D SET566^BPSFLD01 "DATA",9002313.91,222,0) 567^^DUR/PPS RESPONSE CODE COUNTER^N^^^^1^N "DATA",9002313.91,222,5) J6^1^^^29 "DATA",9002313.91,222,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,222,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,222,25,0) ^9002313.9104^1^1^3031210^^ "DATA",9002313.91,222,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,222,30,0) ^9002313.9103^1^1^3031210^^ "DATA",9002313.91,222,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),567.01,DUR,0),U,1)=BPS("X") "DATA",9002313.91,223,0) 568^^PAYER/HEALTH PLAN ID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,223,5) J7^2^^^24 "DATA",9002313.91,223,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,223,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,223,25,0) ^^1^1^3031212^ "DATA",9002313.91,223,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,223,30,0) ^^1^1^3031212^ "DATA",9002313.91,223,30,1,0) S $P(^BPSR(BPS(9002313.02),560),U,8) "DATA",9002313.91,224,0) 569^^PAYER/HEALTH PLAN ID^A/N^^^^10^A/N "DATA",9002313.91,224,5) J8^10^^^24 "DATA",9002313.91,224,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,224,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,224,25,0) ^9002313.9104^1^1^3031212^^ "DATA",9002313.91,224,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,224,30,0) ^9002313.9103^1^1^3031212^^ "DATA",9002313.91,224,30,1,0) S $P(^BPSR(BPS(9002313.02),560),U,9)=BPS("X") "DATA",9002313.91,225,0) 600^^UNIT OF MEASURE^A/N^^^^2^A/N "DATA",9002313.91,225,5) 28^2^^4 "DATA",9002313.91,225,10,0) ^9002313.9101^1^1^3070625 "DATA",9002313.91,225,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Unit of Measure")) "DATA",9002313.91,225,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,225,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,225,25,0) ^9002313.9104^1^1^3070620^ "DATA",9002313.91,225,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,225,30,0) ^9002313.9103^1^1^3070620^ "DATA",9002313.91,225,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),600),U,1)="" "DATA",9002313.91,240,0) 478^^OTHER AMT CLAIMED SBMTTD COUNT^N^^^^1^N "DATA",9002313.91,240,1) OTHER AMOUNT CLAIMED SUBMITTED COUNT "DATA",9002313.91,240,5) H7^1^^10 "DATA",9002313.91,240,10,0) ^9002313.9101^1^1^3101006^^^ "DATA",9002313.91,240,10,1,0) ; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480) "DATA",9002313.91,240,20,0) ^9002313.9102^1^1^3101006^^^ "DATA",9002313.91,240,20,1,0) ; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480) "DATA",9002313.91,240,25,0) ^9002313.9104^1^1^3101006^^ "DATA",9002313.91,240,25,1,0) ; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480) "DATA",9002313.91,240,30,0) ^9002313.9103^1^1^3101006^^ "DATA",9002313.91,240,30,1,0) ; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480) "DATA",9002313.91,241,0) 479^^OTHER AMT CLAIMED SUBM QLFR^A/N^^^^2^A/N "DATA",9002313.91,241,1) OTHER AMOUNT CLAIMED SUBMITTED QUALIFIER "DATA",9002313.91,241,5) H8^2^^10 "DATA",9002313.91,241,10,0) ^9002313.9101^1^1^3101006^^^ "DATA",9002313.91,241,10,1,0) ; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480) "DATA",9002313.91,241,20,0) ^9002313.9102^1^1^3101006^^^ "DATA",9002313.91,241,20,1,0) ; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480) "DATA",9002313.91,241,25,0) ^9002313.9104^1^1^3101006^^ "DATA",9002313.91,241,25,1,0) ; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480) "DATA",9002313.91,241,30,0) ^9002313.9103^1^1^3101006^^ "DATA",9002313.91,241,30,1,0) ; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480) "DATA",9002313.91,242,0) 463^^INTERMEDIARY AUTH TYPE ID^N^^^^2^N "DATA",9002313.91,242,1) INTERMEDIARY AUTHORIZATION TYPE ID "DATA",9002313.91,242,5) EW^2^^4 "DATA",9002313.91,242,10,0) ^^2^2^3110727^ "DATA",9002313.91,242,10,1,0) S BPS("X")=$G(BPS("Claim",BPS(9002313.0201),"Intermediary Auth Type ID")) "DATA",9002313.91,242,10,2,0) S:BPS("X")="" BPS("X")=0 "DATA",9002313.91,242,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,242,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,242,25,0) ^9002313.9104^1^1^3030823^^^^ "DATA",9002313.91,242,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,242,30,0) ^9002313.9103^1^1^3030823^^ "DATA",9002313.91,242,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,3)=BPS("X") "DATA",9002313.91,243,0) E09^^PATIENT MIDDLE NAME^^^^^25^A/N "DATA",9002313.91,243,1) PATIENT MIDDLE NAME "DATA",9002313.91,243,5) 0C^^2309^2 "DATA",9002313.91,243,10,0) ^9002313.9101^1^1^3191009^^^ "DATA",9002313.91,243,10,1,0) S BPS("X")=$G(BPS("Patient","Middle Name")) "DATA",9002313.91,243,20,0) ^9002313.9102^1^1^3191009^^^ "DATA",9002313.91,243,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),25) "DATA",9002313.91,243,30,0) ^9002313.9103^1^1^3191009^^^ "DATA",9002313.91,243,30,1,0) S $P(^BPSC(BPS(9002313.02),"E00"),U,9)=BPS("X") "DATA",9002313.91,244,0) E10^^PATIENT NAME PREFIX^^^^^10^A/N "DATA",9002313.91,244,1) PATIENT NAME PREFIX "DATA",9002313.91,244,5) 0D^^2310^2 "DATA",9002313.91,244,10,0) ^9002313.9101^1^1^3191008^^ "DATA",9002313.91,244,10,1,0) S BPS("X")=$G(BPS("Patient","Prefix")) "DATA",9002313.91,244,20,0) ^9002313.9102^1^1^3191008^^ "DATA",9002313.91,244,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,244,30,0) ^9002313.9103^1^1^3191008^^ "DATA",9002313.91,244,30,1,0) S $P(^BPSC(BPS(9002313.02),"E00"),U,10)=BPS("X") "DATA",9002313.91,245,0) E11^^PATIENT NAME SUFFIX^^^^^10^A/N "DATA",9002313.91,245,1) PATIENT NAME SUFFIX "DATA",9002313.91,245,5) 0E^^2311^2 "DATA",9002313.91,245,10,0) ^^1^1^3191008^ "DATA",9002313.91,245,10,1,0) S BPS("X")=$G(BPS("Patient","Suffix")) "DATA",9002313.91,245,20,0) ^^1^1^3191008^ "DATA",9002313.91,245,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,245,30,0) ^^1^1^3191008^ "DATA",9002313.91,245,30,1,0) S $P(^BPSC(BPS(9002313.02),"E10"),U,1)=BPS("X") "DATA",9002313.91,246,0) E12^^PRESCRIBER MIDDLE NAME^^^^^25^A/N "DATA",9002313.91,246,1) PRESCRIBER MIDDLE NAME "DATA",9002313.91,246,5) 0F^^2312^6 "DATA",9002313.91,246,10,0) ^^1^1^3191008^ "DATA",9002313.91,246,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Middle Name")) "DATA",9002313.91,246,20,0) ^^1^1^3191008^ "DATA",9002313.91,246,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),25) "DATA",9002313.91,246,30,0) ^^1^1^3191008^ "DATA",9002313.91,246,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"E10"),U,2)=BPS("X") "DATA",9002313.91,247,0) E06^^SPECIES^^^^^9^A/N "DATA",9002313.91,247,1) SPECIES "DATA",9002313.91,247,5) S8^^2306^2 "DATA",9002313.91,247,10,0) ^^1^1^3191008^ "DATA",9002313.91,247,10,1,0) S BPS("X")="" "DATA",9002313.91,247,20,0) ^^1^1^3191008^ "DATA",9002313.91,247,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),9) "DATA",9002313.91,247,30,0) ^^1^1^3191008^ "DATA",9002313.91,247,30,1,0) S $P(^BPSC(BPS(9002313.02),"E00"),U,6)=BPS("X") "DATA",9002313.91,248,0) 618^^PATIENT ID COUNT^^^^^1^N "DATA",9002313.91,248,1) PATIENT ID COUNT "DATA",9002313.91,248,5) RR^^^2 "DATA",9002313.91,248,10,0) ^^1^1^3191016^ "DATA",9002313.91,248,10,1,0) S BPS("X")="" "DATA",9002313.91,248,20,0) ^^1^1^3191008^ "DATA",9002313.91,248,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,248,30,0) ^^1^1^3191008^ "DATA",9002313.91,248,30,1,0) S $P(^BPSC(BPS(9002313.02),610),U,8)=BPS("X") "DATA",9002313.91,265,0) 451^^COMPOUND DISP UNIT FORM INDCTR^N^^^^1^N "DATA",9002313.91,265,1) COMPOUND DISPENSING UNIT FORM INDICATOR "DATA",9002313.91,265,5) EG^1^^12 "DATA",9002313.91,265,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,265,10,1,0) S BPS("X")="" "DATA",9002313.91,265,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,265,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,265,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,265,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,266,0) 450^^COMPOUND DOSAGE FORM DESC CODE^A/N^^^^15^A/N "DATA",9002313.91,266,1) COMPOUND DOSAGE FORM DESCRIPTION CODE "DATA",9002313.91,266,5) EF^15^^12 "DATA",9002313.91,266,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,266,10,1,0) S BPS("X")="" "DATA",9002313.91,266,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,266,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,266,25,0) ^9002313.9104^1^1^3040107^^^^ "DATA",9002313.91,266,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,266,30,0) ^9002313.9103^1^1^3040107^^^^ "DATA",9002313.91,266,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),440),U,10)=BPS("X") "DATA",9002313.91,267,0) 490^^COMP INGRED BASIS COST DETERM^A/N^^^^2^A/N "DATA",9002313.91,267,1) COMPOUND INGREDIENT BASIS OF COST DETERMINATION "DATA",9002313.91,267,5) UE^2^^12 "DATA",9002313.91,267,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,267,10,1,0) S BPS("X")="" "DATA",9002313.91,267,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,267,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,267,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,267,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,268,0) 447^^COMPOUND INGREDIENT COMP COUNT^N^^^^2^N "DATA",9002313.91,268,1) COMPOUND INGREDIENT COMPONENT COUNT "DATA",9002313.91,268,5) EC^2^^12 "DATA",9002313.91,268,10,0) ^9002313.9101^1^1^3101115^ "DATA",9002313.91,268,10,1,0) S BPS("X")="" "DATA",9002313.91,268,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,268,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,268,25,0) ^9002313.9104^1^1^3040107^^^^ "DATA",9002313.91,268,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,268,30,0) ^9002313.9103^1^1^3040107^^^^ "DATA",9002313.91,268,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),440),U,7)=BPS("X") "DATA",9002313.91,269,0) 449^^COMPOUND INGREDIENT DRUG COST^N^^^^8^D "DATA",9002313.91,269,5) EE^8^^12 "DATA",9002313.91,269,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,269,10,1,0) S BPS("X")="" "DATA",9002313.91,269,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,269,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,269,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,269,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,271,0) 489^^COMPOUND PRODUCT ID^A/N^^^^19^A/N "DATA",9002313.91,271,5) TE^19^^12 "DATA",9002313.91,271,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,271,10,1,0) S BPS("X")="" "DATA",9002313.91,271,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,271,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19) "DATA",9002313.91,271,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,271,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19) "DATA",9002313.91,272,0) 488^^COMPOUND PRODUCT ID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,272,5) RE^2^^12 "DATA",9002313.91,272,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,272,10,1,0) S BPS("X")="" "DATA",9002313.91,272,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,272,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,272,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,272,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,273,0) 452^^COMPOUND ROUTE OF ADMIN^N^^^^2^N "DATA",9002313.91,273,5) EH^2 "DATA",9002313.91,273,10,0) ^^3^3^3211228^ "DATA",9002313.91,273,10,1,0) S BPS("X")="" "DATA",9002313.91,273,10,2,0) ; Field 452-EH was added to file 9002313.91 in error. It should never "DATA",9002313.91,273,10,3,0) ; appear on a payer sheet, and it should never be populated. "DATA",9002313.91,273,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,273,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,273,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,273,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,308,0) 448^^COMPOUND INGREDIENT QUANTITY^N^^^^10^N "DATA",9002313.91,308,5) ED^10^^12 "DATA",9002313.91,308,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,308,10,1,0) S BPS("X")="" "DATA",9002313.91,308,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,308,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,308,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,308,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,324,0) 494^^MEASUREMENT DATE^A/N^^^^8^N "DATA",9002313.91,324,5) ZE^8^^14 "DATA",9002313.91,324,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,324,10,1,0) S BPS("X")="" "DATA",9002313.91,324,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,324,20,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,324,25,0) ^9002313.9104^1^1^3040224^ "DATA",9002313.91,324,25,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,325,0) 496^^MEASUREMENT DIMENSION^A/N^^^^2^A/N "DATA",9002313.91,325,5) H2^2^^14 "DATA",9002313.91,325,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,325,10,1,0) S BPS("X")="" "DATA",9002313.91,325,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,325,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,325,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,325,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,326,0) 495^^MEASUREMENT TIME^N^^^^4^N "DATA",9002313.91,326,5) H1^4^^14 "DATA",9002313.91,326,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,326,10,1,0) S BPS("X")="" "DATA",9002313.91,326,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,326,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),4) "DATA",9002313.91,326,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,326,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),4) "DATA",9002313.91,327,0) 497^^MEASUREMENT UNIT^A/N^^^^2^A/N "DATA",9002313.91,327,5) H3^2^^14 "DATA",9002313.91,327,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,327,10,1,0) S BPS("X")="" "DATA",9002313.91,327,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,327,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,327,25,0) ^9002313.9104^1^1^3040224^^^^ "DATA",9002313.91,327,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,328,0) 499^^MEASUREMENT VALUE^A/N^^^^15^A/N "DATA",9002313.91,328,5) H4^15^^14 "DATA",9002313.91,328,10,0) ^9002313.9101^1^1^3040224 "DATA",9002313.91,328,10,1,0) S BPS("X")="" "DATA",9002313.91,328,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,328,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,328,25,0) ^9002313.9104^1^1^3040224^^^ "DATA",9002313.91,328,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,329,0) 990^^OTHER PAYER BIN NUMBER^N^^^^6^N "DATA",9002313.91,329,5) MG^6^^3 "DATA",9002313.91,329,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,329,10,1,0) S BPS("X")="" "DATA",9002313.91,329,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,329,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6) "DATA",9002313.91,329,30,0) ^9002313.9103^1^1^3101101^ "DATA",9002313.91,329,30,1,0) S $P(^BPSC(BPS(9002313.02),980),U,10)="" "DATA",9002313.91,330,0) 991^^OTHER PAYER PROC CONTROL NUM^A/N^^^^10^A/N "DATA",9002313.91,330,1) OTHER PAYER PROCESSOR CONTROL NUMBER "DATA",9002313.91,330,5) MH^10^^3^31 "DATA",9002313.91,330,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,330,10,1,0) S BPS("X")="" "DATA",9002313.91,330,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,330,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,330,30,0) ^9002313.9103^1^1^3101101^^ "DATA",9002313.91,330,30,1,0) S $P(^BPSC(BPS(9002313.02),990),U,1)="" "DATA",9002313.91,331,0) 356^^OTHER PAYER CARDHOLDER ID^A/N^^^^20^A/N "DATA",9002313.91,331,5) NU^20^^3^31 "DATA",9002313.91,331,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,331,10,1,0) S BPS("X")="" "DATA",9002313.91,331,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,331,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,331,30,0) ^9002313.9103^1^1^3101101^^ "DATA",9002313.91,331,30,1,0) S $P(^BPSC(BPS(9002313.02),350),U,6)="" "DATA",9002313.91,332,0) 992^^OTHER PAYER GROUP ID^A/N^^^^15^A/N "DATA",9002313.91,332,5) MJ^15^^3^31 "DATA",9002313.91,332,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,332,10,1,0) S BPS("X")="" "DATA",9002313.91,332,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,332,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,332,30,0) ^9002313.9103^1^1^3101101^^ "DATA",9002313.91,332,30,1,0) S $P(^BPSC(BPS(9002313.02),990),U,2)="" "DATA",9002313.91,333,0) 359^^MEDIGAP ID^A/N^^^^20^A/N "DATA",9002313.91,333,5) 2A^20^^3 "DATA",9002313.91,333,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,333,10,1,0) S BPS("X")="" "DATA",9002313.91,333,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,333,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,333,30,0) ^9002313.9103^1^1^3100923^^ "DATA",9002313.91,333,30,1,0) S $P(^BPSC(BPS(9002313.02),350),U,9)="" "DATA",9002313.91,334,0) 360^^MEDICAID INDICATOR^N^^^^2^A/N "DATA",9002313.91,334,5) 2B^2^^3 "DATA",9002313.91,334,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,334,10,1,0) S BPS("X")="" "DATA",9002313.91,334,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,334,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,334,30,0) ^9002313.9103^1^1^3101101^ "DATA",9002313.91,334,30,1,0) S $P(^BPSC(BPS(9002313.02),350),U,10)="" "DATA",9002313.91,335,0) 361^^PROVIDER ACCEPT ASSGNMT INDCTR^A/N^^^^1^A/N "DATA",9002313.91,335,1) PROVIDER ACCEPT ASSIGNMENT INDICATOR "DATA",9002313.91,335,5) 2D^1^^3 "DATA",9002313.91,335,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,335,10,1,0) S BPS("X")="Y" "DATA",9002313.91,335,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,335,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,335,30,0) ^9002313.9103^1^1^3101101^^ "DATA",9002313.91,335,30,1,0) S $P(^BPSC(BPS(9002313.02),360),U,1)=$G(BPS("X")) "DATA",9002313.91,336,0) 997^^CMS PART D DEFND QLFD FACILITY^A/N^^^^1^A/N "DATA",9002313.91,336,1) CMS PART D DEFINED QUALIFIED FACILITY "DATA",9002313.91,336,5) G2^1^^3 "DATA",9002313.91,336,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,336,10,1,0) S BPS("X")="N" "DATA",9002313.91,336,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,336,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,336,30,0) ^9002313.9103^1^1^3101101^^ "DATA",9002313.91,336,30,1,0) S $P(^BPSC(BPS(9002313.02),990),U,7)=$G(BPS("X")) "DATA",9002313.91,337,0) 115^^MEDICAID ID NUMBER^A/N^^^^20^A/N "DATA",9002313.91,337,5) N5^20^^3^24 "DATA",9002313.91,337,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,337,10,1,0) S BPS("X")="" "DATA",9002313.91,337,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,337,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,337,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,337,30,1,0) S $P(^BPSC(BPS(9002313.02),110),U,5)="" "DATA",9002313.91,338,0) 116^^MEDICAID AGENCY NUMBER^A/N^^^^15^A/N "DATA",9002313.91,338,5) N6^15^^3^24 "DATA",9002313.91,338,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,338,10,1,0) S BPS("X")="" "DATA",9002313.91,338,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,338,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,338,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,338,30,1,0) S $P(^BPSC(BPS(9002313.02),110),U,6)="" "DATA",9002313.91,339,0) 384^^PATIENT RESIDENCE^N^^^^2^N "DATA",9002313.91,339,5) 4X^2^^2 "DATA",9002313.91,339,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,339,10,1,0) S BPS("X")=$G(BPS("Patient","Patient Residence")) "DATA",9002313.91,339,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,339,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,339,30,0) ^9002313.9103^1^1^3101007^^^^ "DATA",9002313.91,339,30,1,0) S $P(^BPSC(BPS(9002313.02),380),U,4)=$G(BPS("X")) "DATA",9002313.91,340,0) 354^^SUBMISSION CLARIF CODE COUNT^N^^^^1^N "DATA",9002313.91,340,1) SUBMISSION CLARIFICATION CODE COUNT "DATA",9002313.91,340,5) NX^2^^4 "DATA",9002313.91,340,10,0) ^9002313.9101^1^1^3101006^^ "DATA",9002313.91,340,10,1,0) ; fields 354 & 420 handled by FLD420^BPSOSSG (see SET CODE in field 420) "DATA",9002313.91,340,20,0) ^9002313.9102^1^1^3101006^^ "DATA",9002313.91,340,20,1,0) ; fields 354 & 420 handled by FLD420^BPSOSSG (see SET CODE in field 420) "DATA",9002313.91,340,25,0) ^9002313.9104^1^1^3101006^^ "DATA",9002313.91,340,25,1,0) ; fields 354 & 420 handled by FLD420^BPSOSSG (see SET CODE in field 420) "DATA",9002313.91,340,30,0) ^9002313.9103^1^1^3101006^^^^ "DATA",9002313.91,340,30,1,0) ; fields 354 & 420 handled by FLD420^BPSOSSG (see SET CODE in field 420) "DATA",9002313.91,341,0) 357^^DELAY REASON CODE^N^^^^2^N "DATA",9002313.91,341,5) NV^2^^4 "DATA",9002313.91,341,10,0) ^9002313.9101^1^1^3101007^^ "DATA",9002313.91,341,10,1,0) S BPS("X")=$G(BPS("Claim",BPS(9002313.0201),"Delay Reason Code")) "DATA",9002313.91,341,20,0) ^9002313.9102^1^1^3101012^ "DATA",9002313.91,341,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,341,30,0) ^9002313.9103^1^1^3101007^^ "DATA",9002313.91,341,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),350),U,7)=$S($G(BPS("X"))="NV00":"",1:$G(BPS("X"))) "DATA",9002313.91,342,0) 880^^TRANSACTION REFERENCE NUMBER^A/N^^^^10^A/N "DATA",9002313.91,342,5) K5^10^^4^26 "DATA",9002313.91,342,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,342,10,1,0) S BPS("X")="" "DATA",9002313.91,342,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,342,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,342,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,342,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),870),U,10)="" "DATA",9002313.91,343,0) 391^^PATIENT ASSIGNMENT INDICATOR^A/N^^^^1^A/N "DATA",9002313.91,343,1) PATIENT ASSIGNMENT INDICATOR (DIRECT MEMBER REIMBURSEMENT INDICATOR) "DATA",9002313.91,343,5) MT^1^^4 "DATA",9002313.91,343,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,343,10,1,0) S BPS("X")="Y" "DATA",9002313.91,343,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,343,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,343,30,0) ^9002313.9103^1^1^3101101^^ "DATA",9002313.91,343,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),390),U,1)=$G(BPS("X")) "DATA",9002313.91,344,0) 995^^ROUTE OF ADMINISTRATION^A/N^^^^11^A/N "DATA",9002313.91,344,5) E2^1^^4 "DATA",9002313.91,344,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,344,10,1,0) S BPS("X")="" "DATA",9002313.91,344,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,344,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),11) "DATA",9002313.91,344,30,0) ^9002313.9103^1^1^3101101^^ "DATA",9002313.91,344,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),990),U,5)=$G(BPS("X")) "DATA",9002313.91,345,0) 996^^COMPOUND TYPE^A/N^^^^2^A/N "DATA",9002313.91,345,5) G1^2^^4 "DATA",9002313.91,345,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,345,10,1,0) S BPS("X")="" "DATA",9002313.91,345,20,0) ^9002313.9102^1^1^3101206^ "DATA",9002313.91,345,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,345,30,0) ^^1^1^3121128 "DATA",9002313.91,345,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),990),U,6)="" "DATA",9002313.91,346,0) 114^^MEDICAID SUBROGATION ICN/TCN^A/N^^^^20^A/N "DATA",9002313.91,346,1) MEDICAID SUBROGATION INTERNAL CONTROL NUMBER/TRANSACTION CONTROL NUMBER (ICN/TCN) "DATA",9002313.91,346,5) N4^20^^4^27 "DATA",9002313.91,346,10,0) ^9002313.9101^1^1^3101110^ "DATA",9002313.91,346,10,1,0) S BPS("X")="" "DATA",9002313.91,346,20,0) ^9002313.9102^1^1^3101110^ "DATA",9002313.91,346,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,346,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,346,30,1,0) S $P(^BPSC(BPS(9002313.02),110),U,4)="" "DATA",9002313.91,347,0) 147^^PHARMACY SERVICE TYPE^N^^^^2^N "DATA",9002313.91,347,5) U7^2^^4 "DATA",9002313.91,347,10,0) ^9002313.9101^1^1^3101007^^ "DATA",9002313.91,347,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Pharmacy Service Type")) "DATA",9002313.91,347,20,0) ^9002313.9102^1^1^3101007^^ "DATA",9002313.91,347,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,347,30,0) ^9002313.9103^1^1^3101007^^^^ "DATA",9002313.91,347,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),140),U,7)=$G(BPS("X")) "DATA",9002313.91,348,0) 364^^PRESCRIBER FIRST NAME^A/N^^^^12^A/N "DATA",9002313.91,348,5) 2J^12^^6 "DATA",9002313.91,348,10,0) ^9002313.9101^1^1^3101029^ "DATA",9002313.91,348,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber First Name")) "DATA",9002313.91,348,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,348,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12) "DATA",9002313.91,348,30,0) ^9002313.9103^1^1^3101101^^^ "DATA",9002313.91,348,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,4)=$G(BPS("X")) "DATA",9002313.91,349,0) 365^^PRESCRIBER STREET ADDRESS^A/N^^^^30^A/N "DATA",9002313.91,349,5) 2K^30^^6 "DATA",9002313.91,349,10,0) ^9002313.9101^1^1^3101029^ "DATA",9002313.91,349,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Street Address")) "DATA",9002313.91,349,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,349,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,349,30,0) ^9002313.9103^1^1^3101101^^ "DATA",9002313.91,349,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,5)=$G(BPS("X")) "DATA",9002313.91,350,0) 366^^PRESCRIBER CITY ADDRESS^A/N^^^^20^A/N "DATA",9002313.91,350,5) 2M^20^^6 "DATA",9002313.91,350,10,0) ^9002313.9101^1^1^3101029^ "DATA",9002313.91,350,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber City Address")) "DATA",9002313.91,350,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,350,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,350,30,0) ^9002313.9103^1^1^3101101^^ "DATA",9002313.91,350,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,6)=$G(BPS("X")) "DATA",9002313.91,351,0) 367^^PRESCRIBER STATE/PROV ADDRESS^A/N^^^^2^A/N "DATA",9002313.91,351,1) PRESCRIBER STATE/PROVINCE ADDRESS "DATA",9002313.91,351,5) 2N^2^^6 "DATA",9002313.91,351,10,0) ^9002313.9101^1^1^3101029^^ "DATA",9002313.91,351,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber State/Province Address")) "DATA",9002313.91,351,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,351,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,351,30,0) ^9002313.9103^1^1^3101101^^^ "DATA",9002313.91,351,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,7)=$G(BPS("X")) "DATA",9002313.91,352,0) 368^^PRESCRIBER ZIP/POSTAL ZONE^A/N^^^^15^A/N "DATA",9002313.91,352,5) 2P^2^^6 "DATA",9002313.91,352,10,0) ^9002313.9101^1^1^3101029^ "DATA",9002313.91,352,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Zip/Postal Zone")) "DATA",9002313.91,352,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,352,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,352,30,0) ^9002313.9103^1^1^3101101^^ "DATA",9002313.91,352,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,8)=$G(BPS("X")) "DATA",9002313.91,353,0) 993^^INTERNAL CONTROL NUMBER^A/N^^^^30^A/N "DATA",9002313.91,353,5) A7^30^^7^26 "DATA",9002313.91,353,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,353,10,1,0) S BPS("X")="" "DATA",9002313.91,353,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,353,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,353,30,0) ^9002313.9103^1^1^3101029^ "DATA",9002313.91,353,30,1,0) ; This field currently not implemented "DATA",9002313.91,354,0) 392^^BENEFIT STAGE COUNT^N^^^^1^N "DATA",9002313.91,354,5) MU^1^^7^28 "DATA",9002313.91,354,10,0) ^^1^1^3110727^ "DATA",9002313.91,354,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,354,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,354,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,354,30,0) ^^1^1^3110727^ "DATA",9002313.91,354,30,1,0) D SET392^BPSFLD01 "DATA",9002313.91,355,0) 393^^BENEFIT STAGE QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,355,5) MV^2^^7^28 "DATA",9002313.91,355,10,0) ^^1^1^3110727^ "DATA",9002313.91,355,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,355,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,355,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,355,30,0) ^^1^1^3110727^ "DATA",9002313.91,355,30,1,0) D SET393^BPSFLD01 "DATA",9002313.91,356,0) 394^^BENEFIT STAGE AMOUNT^N^^^^8^D "DATA",9002313.91,356,5) MW^8^^7^28 "DATA",9002313.91,356,10,0) ^^1^1^3110727^ "DATA",9002313.91,356,10,1,0) ;GET code for this COB field is executed in COB^BPSOSHF "DATA",9002313.91,356,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,356,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,356,30,0) ^^1^1^3110727^ "DATA",9002313.91,356,30,1,0) D SET394^BPSFLD01 "DATA",9002313.91,357,0) 117^^BILLING ENTITY TYPE INDICATOR^N^^^^2^N "DATA",9002313.91,357,5) TR^2^^8 "DATA",9002313.91,357,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,357,10,1,0) S BPS("X")="" "DATA",9002313.91,357,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,357,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,357,30,0) ^9002313.9103^1^1^3100924^ "DATA",9002313.91,357,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),110),U,7)="" "DATA",9002313.91,358,0) 118^^PAY TO QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,358,5) TS^2^^8 "DATA",9002313.91,358,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,358,10,1,0) S BPS("X")="" "DATA",9002313.91,358,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,358,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,358,30,0) ^9002313.9103^1^1^3100924^ "DATA",9002313.91,358,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),110),U,8)="" "DATA",9002313.91,359,0) 119^^PAY TO ID^A/N^^^^15^A/N "DATA",9002313.91,359,5) TT^15^^8 "DATA",9002313.91,359,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,359,10,1,0) S BPS("X")="" "DATA",9002313.91,359,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,359,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,359,30,0) ^9002313.9103^1^1^3100924^ "DATA",9002313.91,359,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),110),U,9)="" "DATA",9002313.91,360,0) 120^^PAY TO NAME^A/N^^^^20^A/N "DATA",9002313.91,360,5) TU^20^^8 "DATA",9002313.91,360,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,360,10,1,0) S BPS("X")="" "DATA",9002313.91,360,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,360,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,360,30,0) ^9002313.9103^1^1^3100924^ "DATA",9002313.91,360,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),110),U,10)="" "DATA",9002313.91,361,0) 121^^PAY TO STREET ADDRESS^A/N^^^^30^A/N "DATA",9002313.91,361,5) TV^30^^8 "DATA",9002313.91,361,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,361,10,1,0) S BPS("X")="" "DATA",9002313.91,361,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,361,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,361,30,0) ^9002313.9103^1^1^3100924^ "DATA",9002313.91,361,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),120),U,1)="" "DATA",9002313.91,362,0) 122^^PAY TO CITY ADDRESS^A/N^^^^20^A/N "DATA",9002313.91,362,5) TW^20^^8 "DATA",9002313.91,362,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,362,10,1,0) S BPS("X")="" "DATA",9002313.91,362,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,362,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,362,30,0) ^9002313.9103^1^1^3100924^ "DATA",9002313.91,362,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),120),U,2)="" "DATA",9002313.91,363,0) 124^^PAY TO ZIP/POSTAL ZONE^A/N^^^^15^A/N "DATA",9002313.91,363,5) TY^15^^8 "DATA",9002313.91,363,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,363,10,1,0) S BPS("X")="" "DATA",9002313.91,363,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,363,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,363,30,0) ^9002313.9103^1^1^3100924^ "DATA",9002313.91,363,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),120),U,4)="" "DATA",9002313.91,364,0) 125^^GENERIC EQUIV PROD ID QLFR^A/N^^^^2^A/N "DATA",9002313.91,364,1) GENERIC EQUIVALENT PRODUCT ID QUALIFIER "DATA",9002313.91,364,5) TZ^2^^8 "DATA",9002313.91,364,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,364,10,1,0) S BPS("X")="" "DATA",9002313.91,364,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,364,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,364,30,0) ^9002313.9103^1^1^3100924^ "DATA",9002313.91,364,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),120),U,5)="" "DATA",9002313.91,365,0) 126^^GENERIC EQUIVALENT PRODUCT ID^A/N^^^^19^A/N "DATA",9002313.91,365,5) UA^19^^8 "DATA",9002313.91,365,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,365,10,1,0) S BPS("X")="" "DATA",9002313.91,365,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,365,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19) "DATA",9002313.91,365,30,0) ^9002313.9103^1^1^3100924^ "DATA",9002313.91,365,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),120),U,6)="" "DATA",9002313.91,366,0) 113^^MEDICAID PAID AMOUNT^N^^^^8^D "DATA",9002313.91,366,5) N3^8^^10 "DATA",9002313.91,366,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,366,10,1,0) S BPS("X")="" "DATA",9002313.91,366,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,366,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,366,30,0) ^9002313.9103^1^1^3100924^ "DATA",9002313.91,366,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),110),U,3)="" "DATA",9002313.91,367,0) 362^^COMPOUND INGRED MOD CODE CNT^N^^^^2^N "DATA",9002313.91,367,1) COMPOUND INGREDIENT MODIFIER CODE COUNT "DATA",9002313.91,367,5) 2G^2^^12 "DATA",9002313.91,367,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,367,10,1,0) S BPS("X")="" "DATA",9002313.91,367,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,367,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,367,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,367,30,1,0) ; This field currently not implemented "DATA",9002313.91,368,0) 363^^COMPOUND INGRED MODIFIER CODE^A/N^^^^2^A/N "DATA",9002313.91,368,1) COMPOUND INGREDIENT MODIFIER CODE "DATA",9002313.91,368,5) 2H^2^^12 "DATA",9002313.91,368,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,368,10,1,0) S BPS("X")="" "DATA",9002313.91,368,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,368,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,368,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,368,30,1,0) ; This field currently not implemented "DATA",9002313.91,369,0) 369^^ADDITIONAL DCMNTN TYPE ID^A/N^^^^3^A/N "DATA",9002313.91,369,1) ADDITIONAL DOCUMENTATION TYPE ID "DATA",9002313.91,369,5) 2Q^3^^15 "DATA",9002313.91,369,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,369,10,1,0) S BPS("X")="" "DATA",9002313.91,369,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,369,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,369,30,0) ^9002313.9103^1^1^3101206^^ "DATA",9002313.91,369,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,9)="" "DATA",9002313.91,370,0) 370^^LENGTH OF NEED^N^^^^3^N "DATA",9002313.91,370,5) 2R^3^^15 "DATA",9002313.91,370,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,370,10,1,0) S BPS("X")="" "DATA",9002313.91,370,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,370,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,370,30,0) ^9002313.9103^1^1^3100925^ "DATA",9002313.91,370,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,10)="" "DATA",9002313.91,371,0) 371^^LENGTH OF NEED QUALIFIER^N^^^^2^N "DATA",9002313.91,371,5) 2S^3^^15 "DATA",9002313.91,371,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,371,10,1,0) S BPS("X")="" "DATA",9002313.91,371,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,371,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,371,30,0) ^9002313.9103^1^1^3100925^ "DATA",9002313.91,371,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),370),U,1)="" "DATA",9002313.91,372,0) 372^^PRESCRIBER/SUPPLIER DT SIGNED^N^^^^8^N "DATA",9002313.91,372,1) PRESCRIBER/SUPPLIER DATE SIGNED "DATA",9002313.91,372,5) 2T^9^^15 "DATA",9002313.91,372,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,372,10,1,0) S BPS("X")="" "DATA",9002313.91,372,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,372,20,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,372,30,0) ^9002313.9103^1^1^3100925^ "DATA",9002313.91,372,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),370),U,2)="" "DATA",9002313.91,373,0) 373^^REQUEST STATUS^A/N^^^^1^A/N "DATA",9002313.91,373,5) 2U^1^^15 "DATA",9002313.91,373,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,373,10,1,0) S BPS("X")="" "DATA",9002313.91,373,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,373,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,373,30,0) ^9002313.9103^1^1^3100925^ "DATA",9002313.91,373,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),370),U,3)="" "DATA",9002313.91,374,0) 374^^REQUEST PERIOD BEGIN DATE^N^^^^8^N "DATA",9002313.91,374,5) 2V^8^^15 "DATA",9002313.91,374,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,374,10,1,0) S BPS("X")="" "DATA",9002313.91,374,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,374,20,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,374,30,0) ^9002313.9103^1^1^3100925^ "DATA",9002313.91,374,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),370),U,4)="" "DATA",9002313.91,375,0) 375^^REQ PERIOD RECERT/REVISED DT^N^^^^8^N "DATA",9002313.91,375,1) REQUEST PERIOD RECERT/REVISED DATE "DATA",9002313.91,375,5) 2W^8^^15 "DATA",9002313.91,375,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,375,10,1,0) S BPS("X")="" "DATA",9002313.91,375,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,375,20,1,0) S BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))) "DATA",9002313.91,375,30,0) ^9002313.9103^1^1^3100925^ "DATA",9002313.91,375,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),370),U,5)="" "DATA",9002313.91,376,0) 376^^SUPPORTING DOCUMENTATION^A/N^^^^65^A/N "DATA",9002313.91,376,5) 2X^65^^15 "DATA",9002313.91,376,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,376,10,1,0) S BPS("X")="" "DATA",9002313.91,376,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,376,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),65) "DATA",9002313.91,376,30,0) ^9002313.9103^1^1^3100925^ "DATA",9002313.91,376,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),370),U,6)="" "DATA",9002313.91,377,0) 377^^QUESTION NUMBER/LETTER COUNT^A/N^^^^2^N "DATA",9002313.91,377,5) 2Z^65^^15 "DATA",9002313.91,377,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,377,10,1,0) S BPS("X")="" "DATA",9002313.91,377,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,377,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,378,0) 378^^QUESTION NUMBER/LETTER^A/N^^^^3^A/N "DATA",9002313.91,378,5) 4B^3^^15 "DATA",9002313.91,378,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,378,10,1,0) S BPS("X")="" "DATA",9002313.91,378,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,378,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,378,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,378,30,1,0) ; This field currently not implemented "DATA",9002313.91,379,0) 379^^QUESTION PERCENT RESPONSE^N^^^^5^N "DATA",9002313.91,379,5) 4D^5^^15 "DATA",9002313.91,379,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,379,10,1,0) S BPS("X")="" "DATA",9002313.91,379,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,379,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),5) "DATA",9002313.91,379,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,379,30,1,0) ; This field currently not implemented "DATA",9002313.91,380,0) 380^^QUESTION DATE RESPONSE^N^^^^8^N "DATA",9002313.91,380,5) 4G^8^^15 "DATA",9002313.91,380,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,380,10,1,0) S BPS("X")="" "DATA",9002313.91,380,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,380,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,380,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,380,30,1,0) ; This field currently not implemented "DATA",9002313.91,381,0) 381^^QUESTION DOLLAR AMT RESPONSE^N^^^^11^D "DATA",9002313.91,381,1) QUESTION DOLLAR AMOUNT RESPONSE "DATA",9002313.91,381,5) 4H^9^^15 "DATA",9002313.91,381,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,381,10,1,0) S BPS("X")="" "DATA",9002313.91,381,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,381,20,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),11) "DATA",9002313.91,381,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,381,30,1,0) ; This field currently not implemented "DATA",9002313.91,382,0) 382^^QUESTION NUMERIC RESPONSE^N^^^^11^N "DATA",9002313.91,382,5) 4J^11^^15 "DATA",9002313.91,382,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,382,10,1,0) S BPS("X")="" "DATA",9002313.91,382,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,382,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),11) "DATA",9002313.91,382,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,382,30,1,0) ; This field currently not implemented "DATA",9002313.91,383,0) 383^^QUESTION ALPHANUMERIC RESPONSE^A/N^^^^30^A/N "DATA",9002313.91,383,5) 4K^30^^15 "DATA",9002313.91,383,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,383,10,1,0) S BPS("X")="" "DATA",9002313.91,383,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,383,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,383,30,0) ^9002313.9103^1^1^3101206^ "DATA",9002313.91,383,30,1,0) ; This field currently not implemented "DATA",9002313.91,384,0) 385^^FACILITY NAME^A/N^^^^30^A/N "DATA",9002313.91,384,5) 3Q^30^^16 "DATA",9002313.91,384,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,384,10,1,0) S BPS("X")="" "DATA",9002313.91,384,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,384,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,384,30,0) ^9002313.9103^1^1^3100925^ "DATA",9002313.91,384,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),380),U,5)="" "DATA",9002313.91,385,0) 386^^FACILITY STREET ADDRESS^A/N^^^^30^A/N "DATA",9002313.91,385,5) 3U^30^^16 "DATA",9002313.91,385,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,385,10,1,0) S BPS("X")="" "DATA",9002313.91,385,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,385,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,385,30,0) ^9002313.9103^1^1^3100925^ "DATA",9002313.91,385,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),380),U,6)="" "DATA",9002313.91,386,0) 387^^FACILITY STATE/PROV ADDRESS^A/N^^^^2^A/N "DATA",9002313.91,386,1) FACILITY STATE/PROVINCE ADDRESS "DATA",9002313.91,386,5) 3V^2^^16 "DATA",9002313.91,386,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,386,10,1,0) S BPS("X")="" "DATA",9002313.91,386,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,386,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,386,30,0) ^9002313.9103^1^1^3100925^ "DATA",9002313.91,386,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),380),U,7)="" "DATA",9002313.91,387,0) 388^^FACILITY CITY ADDRESS^A/N^^^^20^A/N "DATA",9002313.91,387,5) 5J^20^^16 "DATA",9002313.91,387,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,387,10,1,0) S BPS("X")="" "DATA",9002313.91,387,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,387,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,387,30,0) ^9002313.9103^1^1^3100925^ "DATA",9002313.91,387,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),380),U,8)="" "DATA",9002313.91,388,0) 389^^FACILITY ZIP/POSTAL ZONE^A/N^^^^15^A/N "DATA",9002313.91,388,5) 6D^16^^16 "DATA",9002313.91,388,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,388,10,1,0) S BPS("X")="" "DATA",9002313.91,388,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,388,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,388,30,0) ^9002313.9103^1^1^3100925^ "DATA",9002313.91,388,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),380),U,9)="" "DATA",9002313.91,389,0) 390^^NARRATIVE MESSAGE^A/N^^^^200^A/N "DATA",9002313.91,389,5) BM^200^^17 "DATA",9002313.91,389,10,0) ^9002313.9101^1^1^3101110^ "DATA",9002313.91,389,10,1,0) S BPS("X")="" "DATA",9002313.91,389,20,0) ^9002313.9102^1^1^3101110^ "DATA",9002313.91,389,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),200) "DATA",9002313.91,389,30,0) ^9002313.9103^1^1^3101110^^ "DATA",9002313.91,389,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),389),U,2)="" "DATA",9002313.91,390,0) 130^^ADDITIONAL MESSAGE INFO COUNT^N^^^^2^N "DATA",9002313.91,390,5) UF^2^^^26 "DATA",9002313.91,390,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,390,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,391,0) 132^^ADDITIONAL MSG INFO QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,391,5) UH^2^^^26 "DATA",9002313.91,391,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,391,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,392,0) 131^^ADDITIONAL MSG INFO CONTINUITY^N^^^^1^A/N "DATA",9002313.91,392,5) UG^2^^^26 "DATA",9002313.91,392,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,392,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,393,0) 987^^URL^A/N^^^^255^A/N "DATA",9002313.91,393,5) MA^255^^^26 "DATA",9002313.91,393,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,393,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,394,0) 571^^AMOUNT ATTRIB TO PROCESSOR FEE^N^^^^8^N "DATA",9002313.91,394,5) NZ^8^^^28 "DATA",9002313.91,394,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,394,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,395,0) 575^^PATIENT PERCENTAGE TAX AMOUNT^N^^^^8^N "DATA",9002313.91,395,5) EQ^8^^^28 "DATA",9002313.91,395,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,395,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,396,0) 574^^PLAN SALES TAX AMOUNT^N^^^^8^N "DATA",9002313.91,396,5) 2Y^8^^^28 "DATA",9002313.91,396,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,396,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,397,0) 572^^AMOUNT OF COINSURANCE^N^^^^8^N "DATA",9002313.91,397,5) 4U^8^^^28 "DATA",9002313.91,397,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,397,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,398,0) 573^^BASIS OF CALC - COINSURANCE^A/N^^^^2^A/N "DATA",9002313.91,398,5) 4V^2^^^28 "DATA",9002313.91,398,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,398,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,399,0) 577^^ESTIMATED GENERIC SAVINGS^N^^^^8^N "DATA",9002313.91,399,5) G3^8^^^28 "DATA",9002313.91,399,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,399,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,400,0) 128^^SPENDING ACCOUNT AMT REMAINING^N^^^^8^N "DATA",9002313.91,400,5) UC^8^^^28 "DATA",9002313.91,400,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,400,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,401,0) 129^^HEALTH PLAN-FUNDED ASSIST AMT^N^^^^8^N "DATA",9002313.91,401,5) UD^8^^^28 "DATA",9002313.91,401,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,401,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,402,0) 133^^AMT ATTR TO PROV NETWORK SLCTN^N^^^^8^N "DATA",9002313.91,402,5) UJ^8^^^28 "DATA",9002313.91,402,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,402,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,403,0) 134^^AMT ATTR TO PROD SEL BRND DRUG^N^^^^8^N "DATA",9002313.91,403,5) UK^8^^^28 "DATA",9002313.91,403,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,403,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,404,0) 135^^AMT ATTR NON-PREF FRMLRY SEL^N^^^^8^N "DATA",9002313.91,404,5) UM^8^^^28 "DATA",9002313.91,404,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,404,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,405,0) 136^^AMT ATTR TO N-PREF FRMLRY SEL^N^^^^8^N "DATA",9002313.91,405,5) UN^8^^^28 "DATA",9002313.91,405,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,405,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,406,0) 137^^AMOUNT ATTR TO COVERAGE GAP^N^^^^8^N "DATA",9002313.91,406,5) UP^8^^^28 "DATA",9002313.91,406,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,406,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,407,0) 148^^INGRED COST CNTRCTD REIMB AMT^N^^^^8^N "DATA",9002313.91,407,5) U8^8^^^28 "DATA",9002313.91,407,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,407,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,408,0) 149^^DISP FEE CNTRCTD REIMB AMT^N^^^^8^N "DATA",9002313.91,408,5) U9^8^^^28 "DATA",9002313.91,408,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,408,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,409,0) 570^^DUR ADDITIONAL TEXT^A/N^^^^100^A/N "DATA",9002313.91,409,5) NS^100^^^29 "DATA",9002313.91,409,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,409,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,410,0) 355^^OTHER PAYER ID COUNT^N^^^^1^N "DATA",9002313.91,410,5) NT^1^^^31 "DATA",9002313.91,410,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,410,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,411,0) 142^^OTHER PAYER PERSON CODE^A/N^^^^3^A/N "DATA",9002313.91,411,5) UV^3^^^31 "DATA",9002313.91,411,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,411,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,412,0) 127^^OTHER PAYER HELP DESK PH NUM^A/N^^^^18^A/N "DATA",9002313.91,412,1) OTHER PAYER HELP DESK TELEPHONE NUMBER "DATA",9002313.91,412,5) UB^18^^^31 "DATA",9002313.91,412,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,412,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,413,0) 143^^OTHER PAYER PATIENT REL CODE^N^^^^1^N "DATA",9002313.91,413,5) UW^1^^^31 "DATA",9002313.91,413,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,413,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,414,0) 144^^OTHER PAYER EFFECTIVE DATE^N^^^^8^N "DATA",9002313.91,414,5) UX^8^^^31 "DATA",9002313.91,414,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,414,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,415,0) 145^^OTHER PAYER TERMINATION DATE^N^^^^8^N "DATA",9002313.91,415,5) UY^8^^^31 "DATA",9002313.91,415,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,415,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,416,0) 139^^MEDICARE PART D COVERAGE CODE^N^^^^2^N "DATA",9002313.91,416,5) UR^2^^^33 "DATA",9002313.91,416,10,0) ^9002313.9101^1^1^3171117^^ "DATA",9002313.91,416,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,417,0) 138^^CMS LICS LEVEL^A/N^^^^20^A/N "DATA",9002313.91,417,5) UQ^20^^^33 "DATA",9002313.91,417,10,0) ^9002313.9101^1^1^3171117^^^ "DATA",9002313.91,417,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,418,0) 240^^CONTRACT NUMBER^A/N^^^^8^A/N "DATA",9002313.91,418,5) U1^8^^^33 "DATA",9002313.91,418,10,0) ^9002313.9101^1^1^3171117^^ "DATA",9002313.91,418,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,419,0) 926^^FORMULARY ID^A/N^^^^10^A/N "DATA",9002313.91,419,5) FF^10^^^33 "DATA",9002313.91,419,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,419,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,420,0) 757^^BENEFIT ID^A/N^^^^15^A/N "DATA",9002313.91,420,5) U6^15^^^33 "DATA",9002313.91,420,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,420,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,421,0) 140^^NEXT MEDICARE PART D EFF DATE^N^^^^8^N "DATA",9002313.91,421,5) US^8^^^33 "DATA",9002313.91,421,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,421,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,422,0) 141^^NEXT MEDICARE PART D TERM DATE^N^^^^8^N "DATA",9002313.91,422,5) UT^8^^^33 "DATA",9002313.91,422,10,0) ^9002313.9101^1^1^3101206^ "DATA",9002313.91,422,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,423,0) 123^^PAY TO STATE/PROVINCE ADDRESS^A/N^^^^2^A/N "DATA",9002313.91,423,1) PAY TO STATE/ PROVINCE ADDRESS "DATA",9002313.91,423,5) TX^2^^8 "DATA",9002313.91,423,10,0) ^9002313.9101^1^1^3101101 "DATA",9002313.91,423,10,1,0) S BPS("X")="" "DATA",9002313.91,423,20,0) ^9002313.9102^1^1^3101101 "DATA",9002313.91,423,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,423,30,0) ^9002313.9103^1^1^3100924^ "DATA",9002313.91,423,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),120),U,3)="" "DATA",9002313.91,424,0) 579^^ASSOC RX/SERVICE PROV ID QUAL^A/N^^^^2^A/N "DATA",9002313.91,424,1) ASSOCIATED PRESCRIPTION / SERVICE PROVIDER ID QUALIFIER "DATA",9002313.91,424,5) XX^2^^4 "DATA",9002313.91,424,10,0) ^^1^1^3130311^ "DATA",9002313.91,424,10,1,0) S BPS("X")="" "DATA",9002313.91,424,20,0) ^9002313.9102^1^1^3130311^^^^ "DATA",9002313.91,424,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,424,25,0) ^9002313.9104^1^1^3130311^^^^ "DATA",9002313.91,424,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,424,30,0) ^9002313.9103^1^1^3130311^^^ "DATA",9002313.91,424,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),570),U,9)=$G(BPS("X")) "DATA",9002313.91,425,0) 580^^ASSOC RX/SERVICE PROVIDER ID^A/N^^^^15^A/N "DATA",9002313.91,425,1) ASSOCIATED PRESCRIPTION / SERVICE PROVIDER ID "DATA",9002313.91,425,5) XY^15^^4 "DATA",9002313.91,425,10,0) ^9002313.9101^1^1^3130222^^ "DATA",9002313.91,425,10,1,0) S BPS("X")="" "DATA",9002313.91,425,20,0) ^9002313.9102^1^1^3130222^^ "DATA",9002313.91,425,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,425,25,0) ^9002313.9104^1^1^3130222^^ "DATA",9002313.91,425,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,425,30,0) ^^1^1^3130222^ "DATA",9002313.91,425,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),570),U,10)=BPS("X") "DATA",9002313.91,426,0) 581^^ASSOC RX/SERVICE REF NUM QUAL^A/N^^^^2^A/N "DATA",9002313.91,426,1) ASSOCIATED PRESCRIPTION / SERVICE REFERENCE NUMBER QUALIFIER "DATA",9002313.91,426,5) XZ^2^^4 "DATA",9002313.91,426,10,0) ^^1^1^3130222^ "DATA",9002313.91,426,10,1,0) S BPS("X")="" "DATA",9002313.91,426,20,0) ^^1^1^3130222^ "DATA",9002313.91,426,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,426,25,0) ^^1^1^3130222^ "DATA",9002313.91,426,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,426,30,0) ^^1^1^3130222^ "DATA",9002313.91,426,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,1)=BPS("X") "DATA",9002313.91,427,0) 582^^ASSOC RX/SERVICE FILL NUMBER^N^^^^2^N "DATA",9002313.91,427,1) ASSOCIATED PRESCRIPTION SERVICE FILL NUMBER "DATA",9002313.91,427,5) X0^2^^4 "DATA",9002313.91,427,10,0) ^^1^1^3130222^ "DATA",9002313.91,427,10,1,0) S BPS("X")="" "DATA",9002313.91,427,20,0) ^^1^1^3130222^ "DATA",9002313.91,427,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,427,25,0) ^^1^1^3130222^ "DATA",9002313.91,427,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,427,30,0) ^^1^1^3130222^ "DATA",9002313.91,427,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,2)=$G(BPS("X")) "DATA",9002313.91,428,0) 583^^SERVICE PROVIDER NAME^A/N^^^^30^A/N "DATA",9002313.91,428,1) SERVICE PROVIDE NAME "DATA",9002313.91,428,5) YK^30^^19 "DATA",9002313.91,428,10,0) ^^1^1^3130228^ "DATA",9002313.91,428,10,1,0) S BPS("X")="" "DATA",9002313.91,428,20,0) ^^1^1^3130222^ "DATA",9002313.91,428,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,428,25,0) ^^1^1^3130222^ "DATA",9002313.91,428,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,428,30,0) ^^1^1^3130222^ "DATA",9002313.91,428,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,3)=BPS("X") "DATA",9002313.91,429,0) 584^^SERVICE PROVIDER STREET^A/N^^^^30^A/N "DATA",9002313.91,429,1) SERVICE PROVIDER STREET ADDRESS "DATA",9002313.91,429,5) YM^30^^19 "DATA",9002313.91,429,10,0) ^^1^1^3130222^ "DATA",9002313.91,429,10,1,0) S BPS("X")="" "DATA",9002313.91,429,20,0) ^^1^1^3130222^ "DATA",9002313.91,429,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,429,25,0) ^^1^1^3130222^ "DATA",9002313.91,429,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,429,30,0) ^^1^1^3130222^ "DATA",9002313.91,429,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,4)=BPS("X") "DATA",9002313.91,430,0) 585^^SERVICE PROVIDER CITY^A/N^^^^20^A/N "DATA",9002313.91,430,1) SERVICE PROVIDER CITY ADDRESS "DATA",9002313.91,430,5) YN^20^^19 "DATA",9002313.91,430,10,0) ^9002313.9101^1^1^3130228^^ "DATA",9002313.91,430,10,1,0) S BPS("X")="" "DATA",9002313.91,430,20,0) ^^1^1^3130222^ "DATA",9002313.91,430,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,430,25,0) ^^1^1^3130222^ "DATA",9002313.91,430,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,430,30,0) ^^1^1^3130222^ "DATA",9002313.91,430,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,5)=BPS("X") "DATA",9002313.91,431,0) 586^^SERVICE PROVIDE STATE/PROVINCE^A/N^^^^2^A/N "DATA",9002313.91,431,1) SERVICE PROVIDER STATE/PROVINCE ADDRESS "DATA",9002313.91,431,5) YP^2^^19 "DATA",9002313.91,431,10,0) ^^1^1^3130222^ "DATA",9002313.91,431,10,1,0) S BPS("X")="" "DATA",9002313.91,431,20,0) ^^1^1^3130222^ "DATA",9002313.91,431,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,431,25,0) ^^1^1^3130222^ "DATA",9002313.91,431,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,431,30,0) ^^1^1^3130222^ "DATA",9002313.91,431,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,6)=BPS("X") "DATA",9002313.91,432,0) 587^^SERVICE PROVIDER ZIP/POST CODE^A/N^^^^15^A/N "DATA",9002313.91,432,1) SERVICE PROVIDER ZIP/POSTAL CODE "DATA",9002313.91,432,5) YQ^15^^19 "DATA",9002313.91,432,10,0) ^9002313.9101^1^1^3130222^^ "DATA",9002313.91,432,10,1,0) S BPS("X")="" "DATA",9002313.91,432,20,0) ^9002313.9102^1^1^3130222^^ "DATA",9002313.91,432,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,432,25,0) ^9002313.9104^1^1^3130222^^ "DATA",9002313.91,432,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,432,30,0) ^^1^1^3130222^ "DATA",9002313.91,432,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,7)=BPS("X") "DATA",9002313.91,433,0) 590^^SELLER INITIALS^A/N^^^^3^A/N "DATA",9002313.91,433,1) SELLER INITIALS "DATA",9002313.91,433,5) YT^3^^19 "DATA",9002313.91,433,10,0) ^^1^1^3130222^ "DATA",9002313.91,433,10,1,0) S BPS("X")=BPS("Provider",MEDN,"Pharmacist Initials") "DATA",9002313.91,433,20,0) ^9002313.9102^1^1^3130222^^^^ "DATA",9002313.91,433,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,433,25,0) ^9002313.9104^1^1^3130222^^^^ "DATA",9002313.91,433,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,433,30,0) ^9002313.9103^1^1^3130222^^^^ "DATA",9002313.91,433,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,10)=BPS("X") "DATA",9002313.91,434,0) 591^^PURCHASER ID QUALIFIER^N^^^^2^N "DATA",9002313.91,434,1) PURCHASER ID QUALIFIER "DATA",9002313.91,434,5) YU^2^^18 "DATA",9002313.91,434,10,0) ^9002313.9101^1^1^3130222^^ "DATA",9002313.91,434,10,1,0) S BPS("X")="" "DATA",9002313.91,434,20,0) ^9002313.9102^1^1^3130222^^ "DATA",9002313.91,434,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,434,25,0) ^9002313.9104^1^1^3130222^^ "DATA",9002313.91,434,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,434,30,0) ^^1^1^3130222^ "DATA",9002313.91,434,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,1)=BPS("X") "DATA",9002313.91,435,0) 592^^PURCHASER ID^A/N^^^^20^A/N "DATA",9002313.91,435,1) PURCHASER ID "DATA",9002313.91,435,5) YV^20^^18 "DATA",9002313.91,435,10,0) ^9002313.9101^1^1^3130222^^ "DATA",9002313.91,435,10,1,0) S BPS("X")="" "DATA",9002313.91,435,20,0) ^9002313.9102^1^1^3130222^^ "DATA",9002313.91,435,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,435,25,0) ^9002313.9104^1^1^3130222^^ "DATA",9002313.91,435,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,435,30,0) ^^1^1^3130222^ "DATA",9002313.91,435,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,2)=BPS("X") "DATA",9002313.91,436,0) 593^^PURCHASER ID STATE/PROVINCE^A/N^^^^2^A/N "DATA",9002313.91,436,1) PURCHASER ID ASSOCIATED STATE/PROVINCE ADDRESS "DATA",9002313.91,436,5) YW^2^^18 "DATA",9002313.91,436,10,0) ^9002313.9101^1^1^3130222^^ "DATA",9002313.91,436,10,1,0) S BPS("X")="" "DATA",9002313.91,436,20,0) ^9002313.9102^1^1^3130222^^ "DATA",9002313.91,436,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,436,25,0) ^9002313.9104^1^1^3130222^^ "DATA",9002313.91,436,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,436,30,0) ^^1^1^3130222^ "DATA",9002313.91,436,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,3)=BPS("X") "DATA",9002313.91,437,0) 594^^PURCHASER DATE OF BIRTH^N^^^^8^N "DATA",9002313.91,437,1) PURCHASER DATE OF BIRTH "DATA",9002313.91,437,5) YX^8^^18 "DATA",9002313.91,437,10,0) ^9002313.9101^1^1^3130228^^^ "DATA",9002313.91,437,10,1,0) S BPS("X")="" "DATA",9002313.91,437,20,0) ^^1^1^3130228^ "DATA",9002313.91,437,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,437,25,0) ^9002313.9104^1^1^3130228^^^ "DATA",9002313.91,437,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,437,30,0) ^9002313.9103^1^1^3130228^^ "DATA",9002313.91,437,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,4)=BPS("X") "DATA",9002313.91,438,0) 595^^PURCHASER GENDER CODE^N^^^^1^N "DATA",9002313.91,438,1) PURCHASER GENDER CODE "DATA",9002313.91,438,5) YY^1^^18 "DATA",9002313.91,438,10,0) ^^1^1^3130228^ "DATA",9002313.91,438,10,1,0) S BPS("X")="" "DATA",9002313.91,438,20,0) ^^1^1^3130222^ "DATA",9002313.91,438,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,438,25,0) ^^1^1^3130222^ "DATA",9002313.91,438,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,438,30,0) ^^1^1^3130222^ "DATA",9002313.91,438,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,5)=BPS("X") "DATA",9002313.91,439,0) 596^^PURCHASER FIRST NAME^A/N^^^^12^A/N "DATA",9002313.91,439,1) PURCHASER FIRST NAME "DATA",9002313.91,439,5) YZ^12^^18 "DATA",9002313.91,439,10,0) ^^1^1^3130222^ "DATA",9002313.91,439,10,1,0) S BPS("X")="" "DATA",9002313.91,439,20,0) ^^1^1^3130222^ "DATA",9002313.91,439,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12) "DATA",9002313.91,439,25,0) ^^1^1^3130222^ "DATA",9002313.91,439,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12) "DATA",9002313.91,439,30,0) ^^1^1^3130222^ "DATA",9002313.91,439,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,6)=BPS("X") "DATA",9002313.91,440,0) 597^^PURCHASER LAST NAME^A/N^^^^15^A/N "DATA",9002313.91,440,1) PURCHASER LAST NAME "DATA",9002313.91,440,5) Y0^15^^18 "DATA",9002313.91,440,10,0) ^9002313.9101^1^1^3130403^^ "DATA",9002313.91,440,10,1,0) S BPS("X")="" "DATA",9002313.91,440,20,0) ^9002313.9102^1^1^3130403^^ "DATA",9002313.91,440,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,440,25,0) ^9002313.9104^1^1^3130403^^ "DATA",9002313.91,440,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,440,30,0) ^9002313.9103^1^1^3130403^^ "DATA",9002313.91,440,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,7)=BPS("X") "DATA",9002313.91,441,0) 598^^PURCHASER STREET ADDRESS^A/N^^^^30^A/N "DATA",9002313.91,441,1) PURCHASER STREET ADDRESS "DATA",9002313.91,441,5) Y1^30^^18 "DATA",9002313.91,441,10,0) ^^1^1^3130222^ "DATA",9002313.91,441,10,1,0) S BPS("X")="" "DATA",9002313.91,441,20,0) ^^1^1^3130222^ "DATA",9002313.91,441,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,441,25,0) ^^1^1^3130222^ "DATA",9002313.91,441,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30) "DATA",9002313.91,441,30,0) ^^1^1^3130222^ "DATA",9002313.91,441,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,8)=BPS("X") "DATA",9002313.91,442,0) 599^^PURCHASER CITY ADDRESS^A/N^^^^20^A/N "DATA",9002313.91,442,1) PURCHASER CITY ADDRESS "DATA",9002313.91,442,5) Y2^20^^18 "DATA",9002313.91,442,10,0) ^^1^1^3130222^ "DATA",9002313.91,442,10,1,0) S BPS("X")="" "DATA",9002313.91,442,20,0) ^^1^1^3130222^ "DATA",9002313.91,442,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,442,25,0) ^^1^1^3130222^ "DATA",9002313.91,442,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,442,30,0) ^^1^1^3130222^ "DATA",9002313.91,442,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,9)=BPS("X") "DATA",9002313.91,443,0) 675^^PURCHASER STATE/PROVINCE CODE^A/N^^^^2^A/N "DATA",9002313.91,443,1) PURCHASER ADDRESS STATE/PROVINCE CODE "DATA",9002313.91,443,5) Y3^2^^18 "DATA",9002313.91,443,10,0) ^9002313.9101^1^1^3130222^^ "DATA",9002313.91,443,10,1,0) S BPS("X")="" "DATA",9002313.91,443,20,0) ^^1^1^3130222^ "DATA",9002313.91,443,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,443,25,0) ^9002313.9104^1^1^3130222^^ "DATA",9002313.91,443,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,443,30,0) ^^1^1^3130222^ "DATA",9002313.91,443,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),670),U,5)=BPS("X") "DATA",9002313.91,444,0) 676^^PURCHASER ZIP/POSTAL CODE^A/N^^^^15^A/N "DATA",9002313.91,444,1) PURCHASER ZIP/POSTAL CODE "DATA",9002313.91,444,5) Y4^15^^18 "DATA",9002313.91,444,10,0) ^9002313.9101^1^1^3130222^^ "DATA",9002313.91,444,10,1,0) S BPS("X")="" "DATA",9002313.91,444,20,0) ^9002313.9102^1^1^3130222^^ "DATA",9002313.91,444,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,444,25,0) ^9002313.9104^1^1^3130222^^ "DATA",9002313.91,444,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,444,30,0) ^9002313.9103^1^1^3130222^^^ "DATA",9002313.91,444,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),670),U,6)=BPS("X") "DATA",9002313.91,445,0) 677^^PURCHASER COUNTRY CODE^A/N^^^^2^A/N "DATA",9002313.91,445,1) PURCHASER COUNTRY CODE "DATA",9002313.91,445,5) Y5^2^^18 "DATA",9002313.91,445,10,0) ^^1^1^3130222^ "DATA",9002313.91,445,10,1,0) S BPS("X")="" "DATA",9002313.91,445,20,0) ^^1^1^3130222^ "DATA",9002313.91,445,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,445,25,0) ^^1^1^3130222^ "DATA",9002313.91,445,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,445,30,0) ^^1^1^3130222^ "DATA",9002313.91,445,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),670),U,7)=BPS("X") "DATA",9002313.91,446,0) 678^^TIME OF SERVICE^N^^^^6^N "DATA",9002313.91,446,1) TIME OF SERVICE "DATA",9002313.91,446,5) Y6^6^^4 "DATA",9002313.91,446,10,0) ^^1^1^3130222^ "DATA",9002313.91,446,10,1,0) S BPS("X")=BPS("Claim",MEDN,"Time of Service") "DATA",9002313.91,446,20,0) ^9002313.9102^1^1^3130222^^ "DATA",9002313.91,446,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6) "DATA",9002313.91,446,25,0) ^9002313.9104^1^1^3130222^^ "DATA",9002313.91,446,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6) "DATA",9002313.91,446,30,0) ^9002313.9103^1^1^3130222^^ "DATA",9002313.91,446,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),670),U,8)=BPS("X") "DATA",9002313.91,447,0) 679^^SELLER ID^A/N^^^^70^A/N "DATA",9002313.91,447,1) SELLER ID "DATA",9002313.91,447,5) Y9^70^^19 "DATA",9002313.91,447,10,0) ^^1^1^3130222^ "DATA",9002313.91,447,10,1,0) S BPS("X")=BPS("Provider",MEDN,"Pharmacist ID") "DATA",9002313.91,447,20,0) ^9002313.9102^1^1^3130222^^ "DATA",9002313.91,447,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),70) "DATA",9002313.91,447,25,0) ^9002313.9104^1^1^3130222^^ "DATA",9002313.91,447,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),70) "DATA",9002313.91,447,30,0) ^9002313.9103^1^1^3130222^^ "DATA",9002313.91,447,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),670),U,9)=BPS("X") "DATA",9002313.91,448,0) 680^^SELLER ID QUALIFIER^N^^^^2^N "DATA",9002313.91,448,1) SELLER ID QUALIFIER "DATA",9002313.91,448,5) ZB^2^^19 "DATA",9002313.91,448,10,0) ^^1^1^3130226^ "DATA",9002313.91,448,10,1,0) S BPS("X")="01" "DATA",9002313.91,448,20,0) ^9002313.9102^1^1^3130222^^ "DATA",9002313.91,448,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,448,25,0) ^9002313.9104^1^1^3130222^^ "DATA",9002313.91,448,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,448,30,0) ^9002313.9103^1^1^3130222^^ "DATA",9002313.91,448,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),670),U,10)=BPS("X") "DATA",9002313.91,449,0) 681^^SALES TRANSACTION ID^A/N^^^^80^A/N "DATA",9002313.91,449,1) SALES TRANSACTION ID "DATA",9002313.91,449,5) ZF^80^^4 "DATA",9002313.91,449,10,0) ^9002313.9101^1^1^3130222^^ "DATA",9002313.91,449,10,1,0) S BPS("X")="" "DATA",9002313.91,449,20,0) ^9002313.9102^1^1^3130222^^ "DATA",9002313.91,449,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),80) "DATA",9002313.91,449,25,0) ^9002313.9104^1^1^3130222^^ "DATA",9002313.91,449,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),80) "DATA",9002313.91,449,30,0) ^9002313.9103^1^1^3130222^^ "DATA",9002313.91,449,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),680),U,1)=BPS("X") "DATA",9002313.91,450,0) A22^^PATIENT ID STATE/PROVINCE^A/N^^^^2^A/N "DATA",9002313.91,450,1) PATIENT ID ASSOCIATED STATE/PROVINCE ADDRESS "DATA",9002313.91,450,5) YR^2^1022^2 "DATA",9002313.91,450,10,0) ^^1^1^3130222^ "DATA",9002313.91,450,10,1,0) S BPS("X")="" "DATA",9002313.91,450,20,0) ^^1^1^3130222^ "DATA",9002313.91,450,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,450,25,0) ^^1^1^3130222^ "DATA",9002313.91,450,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,450,30,0) ^^1^1^3130227^ "DATA",9002313.91,450,30,1,0) S $P(^BPSC(BPS(9002313.02),"A20"),U,2)=BPS("X") "DATA",9002313.91,451,0) A23^^PURCHASER RELATIONSHIP CODE^A/N^^^^2^A/N "DATA",9002313.91,451,1) PURCHASER RELATIONSHIP CODE "DATA",9002313.91,451,5) YS^2^1023^18 "DATA",9002313.91,451,10,0) ^9002313.9101^1^1^3130222^^ "DATA",9002313.91,451,10,1,0) S BPS("X")="" "DATA",9002313.91,451,20,0) ^9002313.9102^1^1^3130222^^ "DATA",9002313.91,451,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,451,25,0) ^^1^1^3130222^ "DATA",9002313.91,451,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,451,30,0) ^9002313.9103^1^1^3130222^^ "DATA",9002313.91,451,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,3)=BPS("X") "DATA",9002313.91,452,0) A24^^PRESCRIBER ID STATE/PROVINCE^A/N^^^^2^A/N "DATA",9002313.91,452,1) PRESCRIBER ID ASSOCIATED STATE/PROVINCE CODE "DATA",9002313.91,452,5) ZK^2^1024^6 "DATA",9002313.91,452,10,0) ^^1^1^3130222^ "DATA",9002313.91,452,10,1,0) S BPS("X")="" "DATA",9002313.91,452,20,0) ^^1^1^3130222^ "DATA",9002313.91,452,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,452,25,0) ^^1^1^3130222^ "DATA",9002313.91,452,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,452,30,0) ^^1^1^3130222^ "DATA",9002313.91,452,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,4)=BPS("X") "DATA",9002313.91,453,0) A25^^PRESCRIBER ALTERNATE ID QUAL^A/N^^^^2^A/N "DATA",9002313.91,453,1) PRESCRIBER ALTERNATE ID QUALIFIER "DATA",9002313.91,453,5) ZM^2^1025^6 "DATA",9002313.91,453,10,0) ^^1^1^3130227^ "DATA",9002313.91,453,10,1,0) S BPS("X")="" "DATA",9002313.91,453,20,0) ^^1^1^3130222^ "DATA",9002313.91,453,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,453,25,0) ^^1^1^3130222^ "DATA",9002313.91,453,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,453,30,0) ^9002313.9103^1^1^3130227^^ "DATA",9002313.91,453,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,5)=BPS("X") "DATA",9002313.91,454,0) A26^^PRESCRIBER ALTERNATE ID^A/N^^^^15^A/N "DATA",9002313.91,454,1) PRESCRIBER ALTERNATE ID "DATA",9002313.91,454,5) ZP^15^1026^6 "DATA",9002313.91,454,10,0) ^^1^1^3130222^ "DATA",9002313.91,454,10,1,0) S BPS("X")="" "DATA",9002313.91,454,20,0) ^^1^1^3130222^ "DATA",9002313.91,454,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,454,25,0) ^^1^1^3130222^ "DATA",9002313.91,454,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,454,30,0) ^^1^1^3130222^ "DATA",9002313.91,454,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,6)=BPS("X") "DATA",9002313.91,455,0) A27^^PRESCRIBER ALTERNATE STATE^A/N^^^^2^A/N "DATA",9002313.91,455,1) PRESCRIBER ALTERNATE ID ASSOCIATED STATE/PROVINCE ADDRESS "DATA",9002313.91,455,5) ZQ^2^1027^6 "DATA",9002313.91,455,10,0) ^^1^1^3130222^ "DATA",9002313.91,455,10,1,0) S BPS("X")="" "DATA",9002313.91,455,20,0) ^^1^1^3130222^ "DATA",9002313.91,455,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,455,25,0) ^^1^1^3130222^ "DATA",9002313.91,455,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,455,30,0) ^^1^1^3130222^ "DATA",9002313.91,455,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,7)=BPS("X") "DATA",9002313.91,456,0) A28^^ADJUDICATED PROGRAM TYPE^N^^^^2^N "DATA",9002313.91,456,1) ADJUDICATED PAYMENT TYPE "DATA",9002313.91,456,5) ZR^2^1028^^26 "DATA",9002313.91,456,10,0) ^^1^1^3130222^ "DATA",9002313.91,456,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,457,0) A29^^REPORTED ADJUDICATED PROG TYPE^N^^^^2^N "DATA",9002313.91,457,1) REPORTED ADJUDICATED PROGRAM TYPE "DATA",9002313.91,457,5) ZS^2^1029^4 "DATA",9002313.91,457,10,0) ^^1^1^3130222^ "DATA",9002313.91,457,10,1,0) S BPS("X")="" "DATA",9002313.91,457,20,0) ^^1^1^3130222^ "DATA",9002313.91,457,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,457,25,0) ^^1^1^3130222^ "DATA",9002313.91,457,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,457,30,0) ^^1^1^3130222^ "DATA",9002313.91,457,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,9)=BPS("X") "DATA",9002313.91,458,0) A30^^RELEASED DATE^N^^^^8^N "DATA",9002313.91,458,1) RELEASED DATE "DATA",9002313.91,458,5) ZT^8^1030^18 "DATA",9002313.91,458,10,0) ^^1^1^3130222^ "DATA",9002313.91,458,10,1,0) S BPS("X")="" "DATA",9002313.91,458,20,0) ^^1^1^3130222^ "DATA",9002313.91,458,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,458,25,0) ^^1^1^3130222^ "DATA",9002313.91,458,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,458,30,0) ^^1^1^3130222^ "DATA",9002313.91,458,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,10)=BPS("X") "DATA",9002313.91,459,0) A31^^RELEASED TIME^N^^^^6^N "DATA",9002313.91,459,1) RELEASED TIME "DATA",9002313.91,459,5) ZU^6^1031^18 "DATA",9002313.91,459,10,0) ^^1^1^3130228^ "DATA",9002313.91,459,10,1,0) S BPS("X")="" "DATA",9002313.91,459,20,0) ^^1^1^3130222^ "DATA",9002313.91,459,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6) "DATA",9002313.91,459,25,0) ^^1^1^3130222^ "DATA",9002313.91,459,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6) "DATA",9002313.91,459,30,0) ^^1^1^3130222^ "DATA",9002313.91,459,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A30"),U,1)=BPS("X") "DATA",9002313.91,460,0) A32^^COMPOUND PREPARATION TIME^N^^^^4^N "DATA",9002313.91,460,1) COMPOUND PREPARATION TIME "DATA",9002313.91,460,5) ZW^4^1032^12 "DATA",9002313.91,460,10,0) ^^1^1^3130222^ "DATA",9002313.91,460,10,1,0) S BPS("X")="" "DATA",9002313.91,460,20,0) ^^1^1^3130222^ "DATA",9002313.91,460,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),4) "DATA",9002313.91,460,25,0) ^^1^1^3130222^ "DATA",9002313.91,460,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),4) "DATA",9002313.91,460,30,0) ^^1^1^3130222^ "DATA",9002313.91,460,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A30"),U,2)=BPS("X") "DATA",9002313.91,461,0) A43^^PATIENT COUNTRY CODE^A/N^^^^2^A/N "DATA",9002313.91,461,1) PATIENT COUNTRY CODE "DATA",9002313.91,461,5) 1K^2^1043^2 "DATA",9002313.91,461,10,0) ^^1^1^3130222^ "DATA",9002313.91,461,10,1,0) S BPS("X")="" "DATA",9002313.91,461,20,0) ^9002313.9102^1^1^3130222^^ "DATA",9002313.91,461,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,461,25,0) ^9002313.9104^1^1^3130222^^ "DATA",9002313.91,461,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,461,30,0) ^^1^1^3130227^ "DATA",9002313.91,461,30,1,0) S $P(^BPSC(BPS(9002313.02),"A40"),U,3)=BPS("X") "DATA",9002313.91,462,0) A45^^VETERINARY USE INDICATOR^A/N^^^^1^A/N "DATA",9002313.91,462,1) VETERINARY USE INDICATOR "DATA",9002313.91,462,5) 1R^1^1045^2 "DATA",9002313.91,462,10,0) ^^1^1^3130222^ "DATA",9002313.91,462,10,1,0) S BPS("X")="" "DATA",9002313.91,462,20,0) ^^1^1^3130222^ "DATA",9002313.91,462,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,462,25,0) ^^1^1^3130222^ "DATA",9002313.91,462,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,462,30,0) ^^1^1^3130227^ "DATA",9002313.91,462,30,1,0) S $P(^BPSC(BPS(9002313.02),"A40"),U,5)=BPS("X") "DATA",9002313.91,463,0) B04^^NEXT AVAILABLE FILL DATE^N^^^^8^N "DATA",9002313.91,463,1) NEXT AVAILABLE FILL DATE "DATA",9002313.91,463,5) BT^8^2004^^26 "DATA",9002313.91,463,10,0) ^^1^1^3130222^ "DATA",9002313.91,463,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,464,0) B08^^PATIENT STREET ADDRESS LINE 1^^^^^40^A/N "DATA",9002313.91,464,5) 7A^^2008^2 "DATA",9002313.91,464,10,0) ^9002313.9101^1^1^3191008^^ "DATA",9002313.91,464,10,1,0) S BPS("X")=$G(BPS("Patient","Street Address Line 1")) "DATA",9002313.91,464,20,0) ^9002313.9102^1^1^3191008^ "DATA",9002313.91,464,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,464,30,0) ^9002313.9103^1^1^3191008^ "DATA",9002313.91,464,30,1,0) S $P(^BPSC(BPS(9002313.02),"B00"),U,8)=BPS("X") "DATA",9002313.91,465,0) B09^^PATIENT STREET ADDRESS LINE 2^^^^^40^A/N "DATA",9002313.91,465,5) 7B^^2009^2 "DATA",9002313.91,465,10,0) ^^1^1^3150112^ "DATA",9002313.91,465,10,1,0) S BPS("X")=$G(BPS("Patient","Street Address Line 2")) "DATA",9002313.91,465,20,0) ^^1^1^3141223 "DATA",9002313.91,465,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,465,30,0) ^^1^1^3141223 "DATA",9002313.91,465,30,1,0) S $P(^BPSC(BPS(9002313.02),"B00"),U,9)=BPS("X") "DATA",9002313.91,466,0) B38^^PATIENT ID ASSOC COUNTRY CODE^^^^^2^A/N "DATA",9002313.91,466,1) PATIENT ID ASSOCIATED COUNTRY CODE "DATA",9002313.91,466,5) 1Y^^2038^2 "DATA",9002313.91,466,10,0) ^^1^1^3141223 "DATA",9002313.91,466,10,1,0) S BPS("X")="US" "DATA",9002313.91,466,20,0) ^^1^1^3141223 "DATA",9002313.91,466,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,466,30,0) ^^1^1^3141223 "DATA",9002313.91,466,30,1,0) S $P(^BPSC(BPS(9002313.02),"B30"),U,8)=BPS("X") "DATA",9002313.91,467,0) B26^^PRESCRIBER PHONE NUMBER EXT^^^^^8^N "DATA",9002313.91,467,1) PRESCRIBER TELEPHONE NUMBER EXTENSION "DATA",9002313.91,467,5) 7T^^2026^6 "DATA",9002313.91,467,10,0) ^^1^1^3141223 "DATA",9002313.91,467,10,1,0) S BPS("X")="" "DATA",9002313.91,467,20,0) ^^1^1^3141223 "DATA",9002313.91,467,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,467,30,0) ^^1^1^3141223 "DATA",9002313.91,467,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,6)=BPS("X") "DATA",9002313.91,468,0) B27^^PRESCRIBER STREET ADDR LINE 1^^^^^40^A/N "DATA",9002313.91,468,1) PRESCRIBER STREET ADDRESS LINE 1 "DATA",9002313.91,468,5) 7U^^2027^6 "DATA",9002313.91,468,10,0) ^^1^1^3150112^ "DATA",9002313.91,468,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Street Address Line 1")) "DATA",9002313.91,468,20,0) ^^1^1^3141223 "DATA",9002313.91,468,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,468,30,0) ^^1^1^3141223 "DATA",9002313.91,468,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,7)=BPS("X") "DATA",9002313.91,469,0) B28^^PRESCRIBER STREET ADDR LINE 2^^^^^40^A/N "DATA",9002313.91,469,1) PRESCRIBER STREET ADDRESS LINE 2 "DATA",9002313.91,469,5) 7V^^2028^6 "DATA",9002313.91,469,10,0) ^^1^1^3150112^ "DATA",9002313.91,469,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Street Address Line 2")) "DATA",9002313.91,469,20,0) ^^1^1^3141223 "DATA",9002313.91,469,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,469,30,0) ^^1^1^3141223 "DATA",9002313.91,469,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,8)=BPS("X") "DATA",9002313.91,470,0) B40^^PRES ALT ID ASSOC COUNTRY CODE^^^^^2^A/N "DATA",9002313.91,470,1) PRESCRIBER ALTERNATE ID ASSOCIATED COUNTRY CODE "DATA",9002313.91,470,5) 3A^^2040^6 "DATA",9002313.91,470,10,0) ^^1^1^3141223 "DATA",9002313.91,470,10,1,0) S BPS("X")="" "DATA",9002313.91,470,20,0) ^^1^1^3141223 "DATA",9002313.91,470,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,470,30,0) ^^1^1^3141223 "DATA",9002313.91,470,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,10)=BPS("X") "DATA",9002313.91,471,0) B41^^PRES ID ASSOC COUNTRY CODE^^^^^2^A/N "DATA",9002313.91,471,1) PRESCRIBER ID ASSOCIATED COUNTRY CODE "DATA",9002313.91,471,5) 3B^^2041^6 "DATA",9002313.91,471,10,0) ^9002313.9101^1^1^3150112^ "DATA",9002313.91,471,10,1,0) S BPS("X")="US" "DATA",9002313.91,471,20,0) ^^1^1^3141223 "DATA",9002313.91,471,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,471,30,0) ^^1^1^3141223 "DATA",9002313.91,471,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B40"),U,1)=BPS("X") "DATA",9002313.91,472,0) B42^^PRESCRIBER COUNTRY CODE^^^^^2^A/N "DATA",9002313.91,472,5) 3C^^2042^6 "DATA",9002313.91,472,10,0) ^^1^1^3150112^ "DATA",9002313.91,472,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Country")) "DATA",9002313.91,472,20,0) ^^1^1^3141223 "DATA",9002313.91,472,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,472,30,0) ^^1^1^3141223 "DATA",9002313.91,472,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B40"),U,2)=BPS("X") "DATA",9002313.91,473,0) B15^^EMPLOYER STREET ADDRESS LINE 1^^^^^40^A/N "DATA",9002313.91,473,5) 8D^^2015^8 "DATA",9002313.91,473,10,0) ^^1^1^3141223 "DATA",9002313.91,473,10,1,0) S BPS("X")="" "DATA",9002313.91,473,20,0) ^^1^1^3141223 "DATA",9002313.91,473,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,473,30,0) ^^1^1^3141223 "DATA",9002313.91,473,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,5)=BPS("X") "DATA",9002313.91,474,0) B16^^EMPLOYER STREET ADDRESS LINE 2^^^^^40^A/N "DATA",9002313.91,474,5) 7G^^2016^8 "DATA",9002313.91,474,10,0) ^^1^1^3141223 "DATA",9002313.91,474,10,1,0) S BPS("X")="" "DATA",9002313.91,474,20,0) ^^1^1^3141223 "DATA",9002313.91,474,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,474,30,0) ^^1^1^3141223 "DATA",9002313.91,474,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,6)=BPS("X") "DATA",9002313.91,475,0) B17^^EMPLOYER CONTACT FIRST NAME^^^^^35^A/N "DATA",9002313.91,475,5) 7H^^2017^8 "DATA",9002313.91,475,10,0) ^^1^1^3141223 "DATA",9002313.91,475,10,1,0) S BPS("X")="" "DATA",9002313.91,475,20,0) ^^1^1^3141223 "DATA",9002313.91,475,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35) "DATA",9002313.91,475,30,0) ^^1^1^3141223 "DATA",9002313.91,475,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,7)=BPS("X") "DATA",9002313.91,476,0) B18^^EMPLOYER CONTACT LAST NAME^^^^^35^A/N "DATA",9002313.91,476,5) 7J^^2018^8 "DATA",9002313.91,476,10,0) ^^1^1^3141223 "DATA",9002313.91,476,10,1,0) S BPS("X")="" "DATA",9002313.91,476,20,0) ^^1^1^3141223 "DATA",9002313.91,476,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35) "DATA",9002313.91,476,30,0) ^^1^1^3141223 "DATA",9002313.91,476,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,8)=BPS("X") "DATA",9002313.91,477,0) B19^^EMPLOYER PHONE NUMBER EXT^^^^^8^N "DATA",9002313.91,477,1) EMPLOYER TELEPHONE NUMBER EXTENSION "DATA",9002313.91,477,5) 7K^^2019^8 "DATA",9002313.91,477,10,0) ^^1^1^3141223 "DATA",9002313.91,477,10,1,0) S BPS("X")="" "DATA",9002313.91,477,20,0) ^^1^1^3141223 "DATA",9002313.91,477,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,477,30,0) ^^1^1^3141223 "DATA",9002313.91,477,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,9)=BPS("X") "DATA",9002313.91,478,0) B24^^PAY TO STREET ADDRESS LINE 1^^^^^40^A/N "DATA",9002313.91,478,5) 7R^^2024^8 "DATA",9002313.91,478,10,0) ^^1^1^3141223 "DATA",9002313.91,478,10,1,0) S BPS("X")="" "DATA",9002313.91,478,20,0) ^^1^1^3141223 "DATA",9002313.91,478,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,478,30,0) ^^1^1^3141223 "DATA",9002313.91,478,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,4)=BPS("X") "DATA",9002313.91,479,0) B25^^PAY TO STREET ADDRESS LINE 2^^^^^40^A/N "DATA",9002313.91,479,5) 7S^^2025^8 "DATA",9002313.91,479,10,0) ^^1^1^3141223 "DATA",9002313.91,479,10,1,0) S BPS("X")="" "DATA",9002313.91,479,20,0) ^^1^1^3141223 "DATA",9002313.91,479,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,479,30,0) ^^1^1^3141223 "DATA",9002313.91,479,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,5)=BPS("X") "DATA",9002313.91,480,0) B35^^EMPLOYER COUNTRY CODE^^^^^2^A/N "DATA",9002313.91,480,5) 1V^^2035^8 "DATA",9002313.91,480,10,0) ^^1^1^3141223 "DATA",9002313.91,480,10,1,0) S BPS("X")="" "DATA",9002313.91,480,20,0) ^^1^1^3141223 "DATA",9002313.91,480,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,480,30,0) ^^1^1^3141223 "DATA",9002313.91,480,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,5)=BPS("X") "DATA",9002313.91,481,0) B39^^PAY TO COUNTRY CODE^^^^^2^A/N "DATA",9002313.91,481,5) 1Z^^2039^8 "DATA",9002313.91,481,10,0) ^^1^1^3141223 "DATA",9002313.91,481,10,1,0) S BPS("X")="" "DATA",9002313.91,481,20,0) ^^1^1^3141223 "DATA",9002313.91,481,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,481,30,0) ^^1^1^3141223 "DATA",9002313.91,481,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,9)=BPS("X") "DATA",9002313.91,482,0) B13^^AUTH REP STREET ADDRESS LINE 1^^^^^40^A/N "DATA",9002313.91,482,1) AUTHORIZED REPRESENTATIVE STREET ADDRESS LINE 1 "DATA",9002313.91,482,5) 7D^^2013^13 "DATA",9002313.91,482,10,0) ^9002313.9101^1^1^3150112^ "DATA",9002313.91,482,10,1,0) S BPS("X")="" "DATA",9002313.91,482,20,0) ^9002313.9102^1^1^3150112^ "DATA",9002313.91,482,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,482,30,0) ^9002313.9103^1^1^3150112^ "DATA",9002313.91,482,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,3)=BPS("X") "DATA",9002313.91,483,0) B14^^AUTH REP STREET ADDRESS LINE 2^^^^^40^A/N "DATA",9002313.91,483,1) AUTHORIZED REPRESENTATIVE STREET ADDRESS LINE 2 "DATA",9002313.91,483,5) 8B^^2014^13 "DATA",9002313.91,483,10,0) ^^1^1^3141223 "DATA",9002313.91,483,10,1,0) S BPS("X")="" "DATA",9002313.91,483,20,0) ^^1^1^3141223 "DATA",9002313.91,483,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,483,30,0) ^^1^1^3141223 "DATA",9002313.91,483,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,4)=BPS("X") "DATA",9002313.91,484,0) B34^^AUTH REP COUNTRY CODE^^^^^2^A/N "DATA",9002313.91,484,1) AUTHORIZED REPRESENTATIVE COUNTRY CODE "DATA",9002313.91,484,5) 1U^^2034^13 "DATA",9002313.91,484,10,0) ^^1^1^3141223 "DATA",9002313.91,484,10,1,0) S BPS("X")="" "DATA",9002313.91,484,20,0) ^^1^1^3141223 "DATA",9002313.91,484,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,484,30,0) ^^1^1^3141223 "DATA",9002313.91,484,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,4)=BPS("X") "DATA",9002313.91,485,0) B20^^FACILITY STREET ADDRESS LINE 1^^^^^40^A/N "DATA",9002313.91,485,5) 7M^^2020^16 "DATA",9002313.91,485,10,0) ^^1^1^3141223 "DATA",9002313.91,485,10,1,0) S BPS("X")="" "DATA",9002313.91,485,20,0) ^^1^1^3141223 "DATA",9002313.91,485,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,485,30,0) ^^1^1^3141223 "DATA",9002313.91,485,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,10)=BPS("X") "DATA",9002313.91,486,0) B21^^FACILITY STREET ADDRESS LINE 2^^^^^40^A/N "DATA",9002313.91,486,5) 7N^^2021^16 "DATA",9002313.91,486,10,0) ^^1^1^3141223 "DATA",9002313.91,486,10,1,0) S BPS("X")="" "DATA",9002313.91,486,20,0) ^^1^1^3141223 "DATA",9002313.91,486,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,486,30,0) ^^1^1^3141223 "DATA",9002313.91,486,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,1)=BPS("X") "DATA",9002313.91,487,0) B37^^FACILITY COUNTRY CODE^^^^^2^A/N "DATA",9002313.91,487,5) 1X^^2037^16 "DATA",9002313.91,487,10,0) ^^1^1^3141223 "DATA",9002313.91,487,10,1,0) S BPS("X")="" "DATA",9002313.91,487,20,0) ^^1^1^3141223 "DATA",9002313.91,487,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,487,30,0) ^^1^1^3141223 "DATA",9002313.91,487,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,7)=BPS("X") "DATA",9002313.91,488,0) B29^^PURCHASER STREET ADDRESS LINE1^^^^^40^A/N "DATA",9002313.91,488,1) PURCHASER STREET ADDRESS LINE 1 "DATA",9002313.91,488,5) 7W^^2029^18 "DATA",9002313.91,488,10,0) ^^1^1^3141223 "DATA",9002313.91,488,10,1,0) S BPS("X")="" "DATA",9002313.91,488,20,0) ^^1^1^3141223 "DATA",9002313.91,488,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,488,30,0) ^^1^1^3141223 "DATA",9002313.91,488,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,9)=BPS("X") "DATA",9002313.91,489,0) B30^^PURCHASER STREET ADDRESS LINE2^^^^^40^A/N "DATA",9002313.91,489,1) PURCHASER STREET ADDRESS LINE 2 "DATA",9002313.91,489,5) 7X^^2030^18 "DATA",9002313.91,489,10,0) ^^1^1^3141223 "DATA",9002313.91,489,10,1,0) S BPS("X")="" "DATA",9002313.91,489,20,0) ^^1^1^3141223 "DATA",9002313.91,489,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,489,30,0) ^^1^1^3141223 "DATA",9002313.91,489,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,10)=BPS("X") "DATA",9002313.91,490,0) B43^^PURCHASER ID ASSOC COUNTRY CD^^^^^2^A/N "DATA",9002313.91,490,1) PURCHASER ID ASSOCIATED COUNTRY CODE "DATA",9002313.91,490,5) 3D^^2043^18 "DATA",9002313.91,490,10,0) ^^1^1^3141223 "DATA",9002313.91,490,10,1,0) S BPS("X")="" "DATA",9002313.91,490,20,0) ^^1^1^3141223 "DATA",9002313.91,490,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,490,30,0) ^^1^1^3141223 "DATA",9002313.91,490,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B40"),U,3)=BPS("X") "DATA",9002313.91,491,0) B31^^SERVICE PROV STREET ADD LINE 1^^^^^40^A/N "DATA",9002313.91,491,1) SERVICE PROVIDER STREET ADDRESS LINE 1 "DATA",9002313.91,491,5) 7Y^^2031^19 "DATA",9002313.91,491,10,0) ^^1^1^3141223 "DATA",9002313.91,491,10,1,0) S BPS("X")="" "DATA",9002313.91,491,20,0) ^^1^1^3141223 "DATA",9002313.91,491,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,491,30,0) ^^1^1^3141223 "DATA",9002313.91,491,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,1)=BPS("X") "DATA",9002313.91,492,0) B32^^SERVICE PROV STREET ADD LINE 2^^^^^40^A/N "DATA",9002313.91,492,1) SERVICE PROVIDER STREET ADDRESS LINE 2 "DATA",9002313.91,492,5) 7Z^^2032^19 "DATA",9002313.91,492,10,0) ^^1^1^3141223 "DATA",9002313.91,492,10,1,0) S BPS("X")="" "DATA",9002313.91,492,20,0) ^^1^1^3141223 "DATA",9002313.91,492,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40) "DATA",9002313.91,492,30,0) ^^1^1^3141223 "DATA",9002313.91,492,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,2)=BPS("X") "DATA",9002313.91,493,0) A93^^SERVICE PROVIDER COUNTRY CODE^^^^^2^A/N "DATA",9002313.91,493,5) 1T^^1093^19 "DATA",9002313.91,493,10,0) ^^1^1^3141223 "DATA",9002313.91,493,10,1,0) S BPS("X")="" "DATA",9002313.91,493,20,0) ^^1^1^3141223 "DATA",9002313.91,493,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,493,30,0) ^^1^1^3141223 "DATA",9002313.91,493,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A90"),U,3)=BPS("X") "DATA",9002313.91,494,0) B44^^INTERMEDIARY ID COUNT^^^^^1^N "DATA",9002313.91,494,5) 8G^^2044^20 "DATA",9002313.91,494,10,0) ^^1^1^3141223 "DATA",9002313.91,494,10,1,0) S BPS("X")="" "DATA",9002313.91,494,20,0) ^^1^1^3141223 "DATA",9002313.91,494,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,494,30,0) ^^1^1^3141223 "DATA",9002313.91,494,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B40"),U,4)=BPS("X") "DATA",9002313.91,495,0) B45^^INTERMEDIARY ID TYPE CODE^^^^^2^A/N "DATA",9002313.91,495,5) 8H^^2045^20 "DATA",9002313.91,495,10,0) ^^1^1^3141223 "DATA",9002313.91,495,10,1,0) S BPS("X")="" "DATA",9002313.91,495,20,0) ^^1^1^3141223 "DATA",9002313.91,495,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,496,0) B46^^INTERMEDIARY ID TYPE ENTITY^^^^^2^A/N "DATA",9002313.91,496,5) 8J^^2046^20 "DATA",9002313.91,496,10,0) ^^1^1^3141223 "DATA",9002313.91,496,10,1,0) S BPS("X")="" "DATA",9002313.91,496,20,0) ^^1^1^3141223 "DATA",9002313.91,496,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,497,0) B47^^INTERMEDIARY ID QUALIFIER^^^^^2^A/N "DATA",9002313.91,497,5) 8K^^2047^20 "DATA",9002313.91,497,10,0) ^^1^1^3141223 "DATA",9002313.91,497,10,1,0) S BPS("X")="" "DATA",9002313.91,497,20,0) ^^1^1^3141223 "DATA",9002313.91,497,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,498,0) B48^^INTERMEDIARY ID^^^^^20^A/N "DATA",9002313.91,498,5) 8M^^2048^20 "DATA",9002313.91,498,10,0) ^^1^1^3141223 "DATA",9002313.91,498,10,1,0) S BPS("X")="" "DATA",9002313.91,498,20,0) ^^1^1^3141223 "DATA",9002313.91,498,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,499,0) B49^^INTERMEDIARY ID STATE/PROV ADD^^^^^2^A/N "DATA",9002313.91,499,1) INTERMEDIARY ID STATE/PROVINCE ADDRESS "DATA",9002313.91,499,5) 8N^^2049^20 "DATA",9002313.91,499,10,0) ^9002313.9101^1^1^3141231^ "DATA",9002313.91,499,10,1,0) S BPS("X")="" "DATA",9002313.91,499,20,0) ^9002313.9102^1^1^3141231^ "DATA",9002313.91,499,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,500,0) B55^^INTERMEDIARY ID COUNTRY CODE^^^^^2^A/N "DATA",9002313.91,500,5) 8U^^2055^20 "DATA",9002313.91,500,10,0) ^^1^1^3141223 "DATA",9002313.91,500,10,1,0) S BPS("X")="" "DATA",9002313.91,500,20,0) ^^1^1^3141223 "DATA",9002313.91,500,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,501,0) B50^^INTERMEDIARY ID RELATION CODE^^^^^1^N "DATA",9002313.91,501,1) INTERMEDIARY ID RELATIONSHIP CODE "DATA",9002313.91,501,5) 8P^^2050^20 "DATA",9002313.91,501,10,0) ^^1^1^3141223 "DATA",9002313.91,501,10,1,0) S BPS("X")="" "DATA",9002313.91,501,20,0) ^^1^1^3141223 "DATA",9002313.91,501,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,502,0) B56^^LAST KNOWN IIN NUMBER^^^^^6^N "DATA",9002313.91,502,5) 3E^^2056^21 "DATA",9002313.91,502,10,0) ^^1^1^3141223 "DATA",9002313.91,502,10,1,0) S BPS("X")="" "DATA",9002313.91,502,20,0) ^^1^1^3141223 "DATA",9002313.91,502,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,502,30,0) ^^1^1^3141223 "DATA",9002313.91,502,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B50"),U,6)=BPS("X") "DATA",9002313.91,503,0) B57^^LAST KNOWN PROCESSOR CNTRL NUM^^^^^10^A/N "DATA",9002313.91,503,1) LAST KNOWN PROCESSOR CONTROL NUMBER "DATA",9002313.91,503,5) 3F^^2057^21 "DATA",9002313.91,503,10,0) ^^1^1^3141223 "DATA",9002313.91,503,10,1,0) S BPS("X")="" "DATA",9002313.91,503,20,0) ^^1^1^3141223 "DATA",9002313.91,503,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) "DATA",9002313.91,503,30,0) ^^1^1^3141223 "DATA",9002313.91,503,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B50"),U,7)=BPS("X") "DATA",9002313.91,504,0) B58^^LAST KNOWN GROUP ID^^^^^15^A/N "DATA",9002313.91,504,5) 3G^^2058^21 "DATA",9002313.91,504,10,0) ^^1^1^3141223 "DATA",9002313.91,504,10,1,0) S BPS("X")="" "DATA",9002313.91,504,20,0) ^^1^1^3141223 "DATA",9002313.91,504,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,504,30,0) ^^1^1^3141223 "DATA",9002313.91,504,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B50"),U,8)=BPS("X") "DATA",9002313.91,505,0) B59^^LAST KNOWN CARDHOLDER ID^^^^^20^A/N "DATA",9002313.91,505,5) 3H^^2059^21 "DATA",9002313.91,505,10,0) ^^1^1^3141223 "DATA",9002313.91,505,10,1,0) S BPS("X")="" "DATA",9002313.91,505,20,0) ^^1^1^3141223 "DATA",9002313.91,505,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20) "DATA",9002313.91,505,30,0) ^^1^1^3141223 "DATA",9002313.91,505,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B50"),U,9)=BPS("X") "DATA",9002313.91,506,0) B60^^YEAR OF LAST PAID CLAIM^^^^^4^N "DATA",9002313.91,506,5) 3J^^2060^21 "DATA",9002313.91,506,10,0) ^9002313.9101^1^1^3150112^ "DATA",9002313.91,506,10,1,0) S BPS("X")="" "DATA",9002313.91,506,20,0) ^^1^1^3150112^ "DATA",9002313.91,506,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),4) "DATA",9002313.91,506,30,0) ^9002313.9103^1^1^3150112^ "DATA",9002313.91,506,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B50"),U,10)=BPS("X") "DATA",9002313.91,507,0) B61^^MONTH OF LAST PAID CLAIM^^^^^2^N "DATA",9002313.91,507,5) 3K^^2061^21 "DATA",9002313.91,507,10,0) ^^1^1^3141223 "DATA",9002313.91,507,10,1,0) S BPS("X")="" "DATA",9002313.91,507,20,0) ^^1^1^3141223 "DATA",9002313.91,507,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,507,30,0) ^^1^1^3141223 "DATA",9002313.91,507,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B60"),U,1)=BPS("X") "DATA",9002313.91,508,0) B22^^HELP DESK TELEPHONE NUMBER EXT^^^^^8^N "DATA",9002313.91,508,1) HELP DESK TELEPHONE NUMBER EXTENSION "DATA",9002313.91,508,5) 7P^^2022^^26 "DATA",9002313.91,508,10,0) ^^1^1^3141223 "DATA",9002313.91,508,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,509,0) B33^^PRO SERVICE FEE CONT/REIM AMT^^^^^6.2^D "DATA",9002313.91,509,1) PROFESSIONAL SERVICE FEE CONTRACTED/REIMBURSEMENT AMOUNT "DATA",9002313.91,509,5) 6G^^2033^^28 "DATA",9002313.91,509,10,0) ^^1^1^3141223 "DATA",9002313.91,509,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,510,0) B23^^OTHER PAYER HELPDESK PHONE EXT^^^^^8^N "DATA",9002313.91,510,1) OTHER PAYER HELP DESK TELEPHONE NUMBER EXTENSION "DATA",9002313.91,510,5) 7Q^^2023^^31 "DATA",9002313.91,510,10,0) ^^1^1^3141223 "DATA",9002313.91,510,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,511,0) B52^^RESPONSE INTERMEDIARY AUTH CNT^^^^^1^N "DATA",9002313.91,511,1) RESPONSE INTERMEDIARY AUTHORIZATION COUNT "DATA",9002313.91,511,5) 8R^^2052^^32 "DATA",9002313.91,511,10,0) ^^1^1^3141223 "DATA",9002313.91,511,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,512,0) B53^^RESPONSE INTERMED AUTH TYPE ID^^^^^2^N "DATA",9002313.91,512,1) RESPONSE INTERMEDIARY AUTHORIZATION TYPE ID "DATA",9002313.91,512,5) 8S^^2053^^32 "DATA",9002313.91,512,10,0) ^^1^1^3141223 "DATA",9002313.91,512,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,513,0) B54^^RESPONSE INTERMEDIARY AUTH ID^^^^^20^A/N "DATA",9002313.91,513,1) RESPONSE INTERMEDIARY AUTHORIZATION ID "DATA",9002313.91,513,5) 8T^^2054^^32 "DATA",9002313.91,513,10,0) ^^1^1^3141223 "DATA",9002313.91,513,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,514,0) B51^^INTERMEDIARY MESSAGE^^^^^200^A/N "DATA",9002313.91,514,5) 8Q^^2051^^32 "DATA",9002313.91,514,10,0) ^^1^1^3141223 "DATA",9002313.91,514,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,515,0) 931^^MAXIMUM AGE QUALIFIER^A/N^^^^1^A/N "DATA",9002313.91,515,1) MAXIMUM AGE QUALIFIER "DATA",9002313.91,515,5) F8^1^^^27 "DATA",9002313.91,515,10,0) ^9002313.9101^1^1^3180522^^ "DATA",9002313.91,515,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,516,0) 932^^MAXIMUM AGE^N^^^^3^N "DATA",9002313.91,516,1) MAXIMUM AGE "DATA",9002313.91,516,5) GA^3^^^27 "DATA",9002313.91,516,10,0) ^9002313.9101^1^1^3180522^^ "DATA",9002313.91,516,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,517,0) 933^^MAXIMUM AMOUNT^N^^^^10^N "DATA",9002313.91,517,1) MAXIMUM AMOUNT "DATA",9002313.91,517,5) GB^10^^^27 "DATA",9002313.91,517,10,0) ^9002313.9101^1^1^3180807^^ "DATA",9002313.91,517,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,518,0) 934^^MAXIMUM AMOUNT QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,518,1) MAXIMUM AMOUNT QUALIFIER "DATA",9002313.91,518,5) GC^2^^^27 "DATA",9002313.91,518,10,0) ^^2^2^3180807^ "DATA",9002313.91,518,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,519,0) 935^^MAXIMUM AMOUNT TIME PERIOD^A/N^^^^2^A/N "DATA",9002313.91,519,1) MAXIMUM AMOUNT TIME PERIOD "DATA",9002313.91,519,5) GF^2^^^27 "DATA",9002313.91,519,10,0) ^^1^1^3180522^ "DATA",9002313.91,519,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,520,0) 936^^MAX AMT TIME PERIOD START DATE^N^^^^8^N "DATA",9002313.91,520,1) MAXIMUM AMOUNT TIME PERIOD START DATE "DATA",9002313.91,520,5) GG^8^^^27 "DATA",9002313.91,520,10,0) ^9002313.9101^1^1^3180524^^^ "DATA",9002313.91,520,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,521,0) 937^^MAX AMT TIME PERIOD END DATE^N^^^^8^N "DATA",9002313.91,521,1) MAXIMUM AMOUNT TIME PERIOD END DATE "DATA",9002313.91,521,5) GH^8^^^27 "DATA",9002313.91,521,10,0) ^9002313.9101^1^1^3200501^^^ "DATA",9002313.91,521,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,522,0) 938^^MAX AMT TIME PERIOD UNITS^N^^^^4^N "DATA",9002313.91,522,1) MAXIMUM AMOUNT TIME PERIOD UNITS "DATA",9002313.91,522,5) GJ^4^^^27 "DATA",9002313.91,522,10,0) ^^1^1^3180522^ "DATA",9002313.91,522,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,523,0) C58^^BENEFIT TYPE OPPORTUNITY^A/N^^^^2^A/N "DATA",9002313.91,523,1) BENEFIT TYPE OPPORTUNITY "DATA",9002313.91,523,5) AE^2^2158^^27 "DATA",9002313.91,523,10,0) ^^1^1^3180522^ "DATA",9002313.91,523,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,524,0) C59^^BENEFIT TYPE OPPORTUNITY COUNT^N^^^^1^N "DATA",9002313.91,524,1) BENEFIT TYPE OPPORTUNITY COUNT "DATA",9002313.91,524,5) AF^1^2159^^27 "DATA",9002313.91,524,10,0) ^^1^1^3180522^ "DATA",9002313.91,524,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,526,0) C66^^HELP DESK BUSINESS UNIT TYPE^A/N^^^^2^A/N "DATA",9002313.91,526,1) HELP DESK BUSINESS UNIT TYPE "DATA",9002313.91,526,5) BA^2^2166^^26 "DATA",9002313.91,526,10,0) ^^1^1^3180522^ "DATA",9002313.91,526,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,527,0) C67^^HELP DESK BUS UNIT TYPE COUNT^N^^^^2^N "DATA",9002313.91,527,1) HELP DESK BUSINESS UNIT TYPE COUNT "DATA",9002313.91,527,5) BB^2^2167^^26 "DATA",9002313.91,527,10,0) ^^1^1^3180522^ "DATA",9002313.91,527,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,528,0) C68^^HELP DESK CONTACT INFORMATION^A/N^^^^255^A/N "DATA",9002313.91,528,1) HELP DESK CONTACT INFORMATION "DATA",9002313.91,528,5) BC^255^2168^^26 "DATA",9002313.91,528,10,0) ^^1^1^3180522^ "DATA",9002313.91,528,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,529,0) C69^^HELP DESK CONTACT INFO EXT^A/N^^^^8^A/N "DATA",9002313.91,529,1) HELP DESK CONTACT INFORMATION EXTENSION "DATA",9002313.91,529,5) BD^8^2169^^26 "DATA",9002313.91,529,10,0) ^^1^1^3180522^ "DATA",9002313.91,529,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,530,0) C70^^HELP DESK CONTACT INFO QUAL^A/N^^^^2^A/N "DATA",9002313.91,530,1) HELP DESK CONTACT INFORMATION QUALIFIER "DATA",9002313.91,530,5) BF^2^2170^^26 "DATA",9002313.91,530,10,0) ^^1^1^3180522^ "DATA",9002313.91,530,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,531,0) C71^^HELP DESK SUPPORT TYPE^A/N^^^^2^A/N "DATA",9002313.91,531,1) HELP DESK SUPPORT TYPE "DATA",9002313.91,531,5) BG^2^2171^^26 "DATA",9002313.91,531,10,0) ^^1^1^3180522^ "DATA",9002313.91,531,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,532,0) C72^^HELP DESK SUPPORT TYPE COUNT^N^^^^2^N "DATA",9002313.91,532,1) HELP DESK SUPPORT TYPE COUNT "DATA",9002313.91,532,5) BH^2^2172^^26 "DATA",9002313.91,532,10,0) ^^1^1^3180522^ "DATA",9002313.91,532,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,533,0) C80^^INTERMEDIARY HELP DESK TYPE^A/N^^^^2^A/N "DATA",9002313.91,533,1) INTERMEDIARY HELP DESK BUSINESS UNIT TYPE "DATA",9002313.91,533,5) G8^2^2180^^32 "DATA",9002313.91,533,10,0) ^^1^1^3180522^ "DATA",9002313.91,533,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,534,0) C81^^INTERMEDIARY HLPDSK BUS COUNT^A/N^^^^2^A/N "DATA",9002313.91,534,1) INTERMEDIARY HELP DESK BUSINESS UNIT TYPE COUNT "DATA",9002313.91,534,5) G9^2^2181^^32 "DATA",9002313.91,534,10,0) ^^1^1^3180522^ "DATA",9002313.91,534,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,535,0) C82^^INTERMEDIARY HLPDSK CONTACT^A/N^^^^255^A/N "DATA",9002313.91,535,1) INTERMEDIARY HELP DESK CONTACT INFORMATION "DATA",9002313.91,535,5) JP^255^2182^^32 "DATA",9002313.91,535,10,0) ^^1^1^3180522^ "DATA",9002313.91,535,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,536,0) C83^^INTERMEDIARY HLPDSK EXTENSION^A/N^^^^8^A/N "DATA",9002313.91,536,1) INTERMEDIARY HELP DESK CONTACT INFORMATION EXTENSION "DATA",9002313.91,536,5) JR^8^2183^^32 "DATA",9002313.91,536,10,0) ^^1^1^3180522^ "DATA",9002313.91,536,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,537,0) C84^^INTERMEDIARY HLPDSK QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,537,1) INTERMEDIARY HELP DESK CONTACT INFORMATION QUALIFIER "DATA",9002313.91,537,5) KA^2^2184^^32 "DATA",9002313.91,537,10,0) ^^1^1^3180522^ "DATA",9002313.91,537,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,538,0) C85^^INTERMEDIARY HLPDSK SUPPT TYPE^A/N^^^^2^A/N "DATA",9002313.91,538,1) INTERMEDIARY HELP DESK SUPPORT TYPE "DATA",9002313.91,538,5) KB^2^2185^^32 "DATA",9002313.91,538,10,0) ^^1^1^3180522^ "DATA",9002313.91,538,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,540,0) C93^^PATIENT PAY COMPONENT AMOUNT^N^^^^8^N "DATA",9002313.91,540,1) PATIENT PAY COMPONENT AMOUNT "DATA",9002313.91,540,5) KN^8^2193^^28 "DATA",9002313.91,540,10,0) ^^1^1^3180522^ "DATA",9002313.91,540,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,540,25,0) ^^1^1^3180606^ "DATA",9002313.91,540,25,1,0) S BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,540,30,0) ^9002313.9103^1^1^3180606^^ "DATA",9002313.91,540,30,1,0) S $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),"C90"),"^",3)=BPS("X") "DATA",9002313.91,541,0) C94^^PATIENT PAY COMPONENT COUNT^N^^^^2^N "DATA",9002313.91,541,1) PATIENT PAY COMPONENT COUNT "DATA",9002313.91,541,5) KP^2^2194^^28 "DATA",9002313.91,541,10,0) ^^1^1^3180522^ "DATA",9002313.91,541,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,542,0) C95^^PATIENT PAY COMPONENT QUAL^A/N^^^^2^A/N "DATA",9002313.91,542,1) PATIENT PAY COMPONENT QUALIFIER "DATA",9002313.91,542,5) KQ^2^2195^^28 "DATA",9002313.91,542,10,0) ^^1^1^3180522^ "DATA",9002313.91,542,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,543,0) C96^^PAYER/HEALTH PLAN ID COUNT^N^^^^1^N "DATA",9002313.91,543,1) PAYER/HEALTH PLAN ID COUNT "DATA",9002313.91,543,5) KR^1^2196^^24 "DATA",9002313.91,543,10,0) ^^1^1^3180522^ "DATA",9002313.91,543,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,544,0) D15^^SUBROGTN REQUESTR RECONCIL ID^A/N^^^^30^A/N "DATA",9002313.91,544,1) SUBROGATION REQUESTORS RECONCILIATION ID "DATA",9002313.91,544,5) KY^30^2215^^27 "DATA",9002313.91,544,10,0) ^^1^1^3180522^ "DATA",9002313.91,544,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,545,0) D19^^MINIMUM AMOUNT^N^^^^10^N "DATA",9002313.91,545,1) MINIMUM AMOUNT "DATA",9002313.91,545,5) M1^10^2219^^27 "DATA",9002313.91,545,10,0) ^^1^1^3180522^ "DATA",9002313.91,545,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,546,0) D20^^MINIMUM AMOUNT QUALIFIER^A/N^^^^3^A/N "DATA",9002313.91,546,1) MINIMUM AMOUNT QUALIFIER "DATA",9002313.91,546,5) M2^3^2220^^27 "DATA",9002313.91,546,10,0) ^^1^1^3180522^ "DATA",9002313.91,546,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,547,0) D23^^OTHER PAYER NAME^A/N^^^^70^A/N "DATA",9002313.91,547,1) OTHER PAYER NAME "DATA",9002313.91,547,5) M5^70^2223^^31 "DATA",9002313.91,547,10,0) ^^1^1^3180522^ "DATA",9002313.91,547,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,548,0) D24^^REMAINING AMOUNT^N^^^^10^N "DATA",9002313.91,548,1) REMAINING AMOUNT "DATA",9002313.91,548,5) M6^10^2224^^27 "DATA",9002313.91,548,10,0) ^^1^1^3180522^ "DATA",9002313.91,548,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,549,0) D25^^REMAINING AMOUNT QUALIFIER^A/N^^^^3^A/N "DATA",9002313.91,549,1) REMAINING AMOUNT QUALIFIER "DATA",9002313.91,549,5) M7^3^2225^^27 "DATA",9002313.91,549,10,0) ^^1^1^3180522^ "DATA",9002313.91,549,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,550,0) D41^^OTHER PAYER RELATIONSHIP TYPE^A/N^^^^3^A/N "DATA",9002313.91,550,1) OTHER PAYER RELATIONSHIP TYPE "DATA",9002313.91,550,5) PQ^3^2241^^31 "DATA",9002313.91,550,10,0) ^^1^1^3180522^ "DATA",9002313.91,550,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,551,0) D42^^FORMULARY ALT BENEFIT TIER^A/N^^^^2^A/N "DATA",9002313.91,551,1) FORMULARY ALTERNATIVE PLAN BENEFIT TIER "DATA",9002313.91,551,5) PV^2^2242^^27 "DATA",9002313.91,551,10,0) ^^1^1^3180522^ "DATA",9002313.91,551,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,552,0) D43^^FORMULARY ALT REASON CODE^A/N^^^^2^A/N "DATA",9002313.91,552,1) FORMULARY ALTERNATIVE REASON CODE "DATA",9002313.91,552,5) PZ^2^2243^^27 "DATA",9002313.91,552,10,0) ^^1^1^3180522^ "DATA",9002313.91,552,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,553,0) D44^^FORMLRY ALT REQ THERAPY COUNT^A/N^^^^2^A/N "DATA",9002313.91,553,1) FORMULARY ALTERNATIVE REQUIRED THERAPY INDICATOR COUNT "DATA",9002313.91,553,5) P0^2^2244^^27 "DATA",9002313.91,553,10,0) ^9002313.9101^1^1^3180522^^ "DATA",9002313.91,553,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,554,0) D45^^FORMLRY ALT THERAPY INDICATOR^A/N^^^^2^A/N "DATA",9002313.91,554,1) FORMULARY ALTERNATIVE REQUIRED THERAPY INDICATOR "DATA",9002313.91,554,5) P1^2^2245^^27 "DATA",9002313.91,554,10,0) ^^1^1^3180522^ "DATA",9002313.91,554,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,555,0) D46^^FORMLRY ALT THERAPY TIME QUAL^A/N^^^^2^A/N "DATA",9002313.91,555,1) FORMULARY ALTERNATIVE REQUIRED THERAPY TIME PERIOD QUALIFIER "DATA",9002313.91,555,5) P2^2^2246^^27 "DATA",9002313.91,555,10,0) ^^1^1^3180522^ "DATA",9002313.91,555,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,556,0) D47^^FORMLRY ALT THERAPY DURATION^A/N^^^^3^A/N "DATA",9002313.91,556,1) FORMULARY ALTERNATIVE REQUIRED THERAPY TIME PERIOD DURATION "DATA",9002313.91,556,5) P3^3^2247^^27 "DATA",9002313.91,556,10,0) ^^1^1^3180522^ "DATA",9002313.91,556,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,557,0) D48^^FORMLRY ALT THERAPY START DATE^N^^^^8^N "DATA",9002313.91,557,1) FORMULARY ALTERNATIVE REUQIRED THERAPY TIME PERIOD START DATE "DATA",9002313.91,557,5) P4^8^2248^^27 "DATA",9002313.91,557,10,0) ^^1^1^3180522^ "DATA",9002313.91,557,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,558,0) D49^^FORMLRY ALT THERAPY END DATE^N^^^^9^N "DATA",9002313.91,558,1) FORMULARY ALTERNATIVE REQUIRED THERAPY TIME PERIOD END DATE "DATA",9002313.91,558,5) P5^9^2249^^27 "DATA",9002313.91,558,10,0) ^^1^1^3180522^ "DATA",9002313.91,558,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,559,0) D50^^OTHER PAYER BENEFIT CLASS^A/N^^^^10^A/N "DATA",9002313.91,559,1) OTHER PAYER BENEFIT CLASSIFICATION "DATA",9002313.91,559,5) P6^10^2250^^31 "DATA",9002313.91,559,10,0) ^^1^1^3180522^ "DATA",9002313.91,559,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,560,0) D54^^PLAN OVERRIDE INDICATOR^A/N^^^^6^A/N "DATA",9002313.91,560,1) PLAN BENEFIT OVERRIDE INDICATOR "DATA",9002313.91,560,5) RC^6^2254^^27 "DATA",9002313.91,560,10,0) ^^1^1^3180522^ "DATA",9002313.91,560,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,561,0) D55^^PLAN OVERRIDE VALUE COUNT^N^^^^1^N "DATA",9002313.91,561,1) PLAN BENEFIT OVERRIDE VALUE COUNT "DATA",9002313.91,561,5) RD^1^2255^^27 "DATA",9002313.91,561,10,0) ^^1^1^3180522^ "DATA",9002313.91,561,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,562,0) D56^^PLAN BENEFIT OVERRIDE VALUE^N^^^^1^N "DATA",9002313.91,562,1) PLAN BENEFIT OVERRIDE VALUE "DATA",9002313.91,562,5) RF^1^2256^^27 "DATA",9002313.91,562,10,0) ^^1^1^3180522^ "DATA",9002313.91,562,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,563,0) D62^^REGULATORY FEE EXMPT INDICATOR^A/N^^^^1^A/N "DATA",9002313.91,563,1) REGULATORY FEE EXEMPT INDICATOR "DATA",9002313.91,563,5) RM^1^2262^^28 "DATA",9002313.91,563,10,0) ^^1^1^3180522^ "DATA",9002313.91,563,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,564,0) D65^^PATIENT REGULATORY FEE AMOUNT^N^^^^8^N "DATA",9002313.91,564,1) PATIENT REGULATORY FEE AMOUNT "DATA",9002313.91,564,5) RS^8^2265^^28 "DATA",9002313.91,564,10,0) ^^1^1^3180522^ "DATA",9002313.91,564,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,565,0) D17^^SUBMISSION TYPE CODE^A/N^^^^2^A/N "DATA",9002313.91,565,1) SUBMISSION TYPE CODE "DATA",9002313.91,565,5) K8^2^2217^4 "DATA",9002313.91,565,10,0) ^9002313.9101^1^1^3180521^^^ "DATA",9002313.91,565,10,1,0) S BPS("X")="" "DATA",9002313.91,565,20,0) ^9002313.9102^1^1^3180521^^^ "DATA",9002313.91,565,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,565,25,0) ^9002313.9104^1^1^3180510^^ "DATA",9002313.91,565,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,565,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,565,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D10"),U,7)=BPS("X") "DATA",9002313.91,566,0) D18^^DO NOT DISPENSE BEFORE DATE^N^^^^8^N "DATA",9002313.91,566,1) DO NOT DISPENSE BEFORE DATE "DATA",9002313.91,566,5) K9^8^2218^4 "DATA",9002313.91,566,10,0) ^9002313.9101^1^1^3180521^^^ "DATA",9002313.91,566,10,1,0) S BPS("X")="" "DATA",9002313.91,566,20,0) ^9002313.9102^1^1^3180521^^^ "DATA",9002313.91,566,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,566,25,0) ^9002313.9104^1^1^3180510^^ "DATA",9002313.91,566,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,566,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,566,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D10"),U,8)=BPS("X") "DATA",9002313.91,567,0) D21^^MULTIPLE RX/SVC GROUP ID^A/N^^^^35^A/N "DATA",9002313.91,567,1) MULTIPLE PRESCRIPTION/SERVICE ORDER GROUP ID "DATA",9002313.91,567,5) M3^35^2221^4 "DATA",9002313.91,567,10,0) ^9002313.9101^1^1^3180521^^^ "DATA",9002313.91,567,10,1,0) S BPS("X")="" "DATA",9002313.91,567,20,0) ^9002313.9102^1^1^3180521^^^ "DATA",9002313.91,567,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35) "DATA",9002313.91,567,25,0) ^9002313.9104^1^1^3180510^^ "DATA",9002313.91,567,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35) "DATA",9002313.91,567,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,567,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D20"),U,1)=BPS("X") "DATA",9002313.91,568,0) D22^^MULT RX/SVC GROUP REASON CODE^A/N^^^^2^A/N "DATA",9002313.91,568,1) MULTIPLE PRESCRIPTION/SERVICE ORDER GROUP REASON CODE "DATA",9002313.91,568,5) M4^2^2222^4 "DATA",9002313.91,568,10,0) ^9002313.9101^1^1^3180521^^^ "DATA",9002313.91,568,10,1,0) S BPS("X")="" "DATA",9002313.91,568,20,0) ^9002313.9102^1^1^3180521^^^ "DATA",9002313.91,568,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,568,25,0) ^9002313.9104^1^1^3180510^^ "DATA",9002313.91,568,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,568,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,568,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D20"),U,2)=BPS("X") "DATA",9002313.91,569,0) D51^^OTHER PAYR TAX EXEMPT INDICATR^A/N^^^^1^A/N "DATA",9002313.91,569,1) OTHER PAYER PERCENTAGE TAX EXEMPT INDICATOR "DATA",9002313.91,569,5) P7^1^2251^7 "DATA",9002313.91,569,10,0) ^9002313.9101^1^1^3180521^^^ "DATA",9002313.91,569,10,1,0) S BPS("X")="" "DATA",9002313.91,569,20,0) ^9002313.9102^1^1^3180521^^^ "DATA",9002313.91,569,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,569,25,0) ^9002313.9104^1^1^3180510^^ "DATA",9002313.91,569,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,569,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,569,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D50"),U,1)=BPS("X") "DATA",9002313.91,570,0) D52^^OTHER PAYR FEE EXMPT INDICATR^A/N^^^^1^A/N "DATA",9002313.91,570,1) OTHER PAYER REGULATORY FEE EXEMPT INDICATOR "DATA",9002313.91,570,5) P8^1^2252^7 "DATA",9002313.91,570,10,0) ^9002313.9101^1^1^3180521^^^ "DATA",9002313.91,570,10,1,0) S BPS("X")="" "DATA",9002313.91,570,20,0) ^9002313.9102^1^1^3180521^^^ "DATA",9002313.91,570,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,570,25,0) ^9002313.9104^1^1^3180510^^ "DATA",9002313.91,570,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,570,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,570,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D50"),U,2)=BPS("X") "DATA",9002313.91,571,0) D53^^OTHER PAYR FEE TYPE COUNT^N^^^^1^N "DATA",9002313.91,571,1) OTHER PAYER REGULATORY FEE TYPE COUNT "DATA",9002313.91,571,5) P9^1^2253^7 "DATA",9002313.91,571,10,0) ^9002313.9101^1^1^3180521^^^ "DATA",9002313.91,571,10,1,0) S BPS("X")="" "DATA",9002313.91,571,20,0) ^9002313.9102^1^1^3180521^^^ "DATA",9002313.91,571,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,571,25,0) ^9002313.9104^1^1^3180510^^ "DATA",9002313.91,571,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,571,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,571,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D50"),U,3)=BPS("X") "DATA",9002313.91,572,0) D57^^PRESCRIBER PLACE OF SERVICE^N^^^^2^N "DATA",9002313.91,572,1) PRESCRIBER PLACE OF SERVICE "DATA",9002313.91,572,5) RG^2^2257^6 "DATA",9002313.91,572,10,0) ^9002313.9101^1^1^3180521^^^ "DATA",9002313.91,572,10,1,0) S BPS("X")="" "DATA",9002313.91,572,20,0) ^9002313.9102^1^1^3180521^^^ "DATA",9002313.91,572,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,572,25,0) ^9002313.9104^1^1^3180510^^ "DATA",9002313.91,572,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,572,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,572,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D50"),U,7)=BPS("X") "DATA",9002313.91,573,0) D63^^OTHER PAYER FEE TYPE CODE^A/N^^^^2^A/N "DATA",9002313.91,573,1) OTHER PAYER REGULATORY FEE TYPE CODE "DATA",9002313.91,573,5) RN^2^2263^7 "DATA",9002313.91,573,10,0) ^9002313.9101^1^1^3180521^^^ "DATA",9002313.91,573,10,1,0) S BPS("X")="" "DATA",9002313.91,573,20,0) ^9002313.9102^1^1^3180521^^^ "DATA",9002313.91,573,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,573,25,0) ^9002313.9104^1^1^3180510^^ "DATA",9002313.91,573,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,573,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,573,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D60"),U,3)=BPS("X") "DATA",9002313.91,574,0) C49^^OTHER PAYER RECONCILIATION ID^A/N^^^^30^A/N "DATA",9002313.91,574,1) OTHER PAYER RECONCILIATION ID "DATA",9002313.91,574,5) 9V^30^2149^7 "DATA",9002313.91,574,10,0) ^9002313.9101^1^1^3180521^^^^ "DATA",9002313.91,574,10,1,0) ; Handled by SET2149^BPSFLD01 "DATA",9002313.91,574,20,0) ^9002313.9102^1^1^3180521^^^^ "DATA",9002313.91,574,20,1,0) ; Handled by SET2149^BPSFLD01 "DATA",9002313.91,574,25,0) ^9002313.9104^1^1^3180510^^ "DATA",9002313.91,574,25,1,0) ; Handled by SET2149^BPSFLD01 "DATA",9002313.91,574,30,0) ^9002313.9103^1^1^3180521^^^^ "DATA",9002313.91,574,30,1,0) D SET2149^BPSFLD01 "DATA",9002313.91,575,0) C60^^COMPOUND LEVEL OF COMPLEXITY^A/N^^^^2^A/N "DATA",9002313.91,575,1) COMPOUND LEVEL OF COMPLEXITY "DATA",9002313.91,575,5) AG^2^2160^12 "DATA",9002313.91,575,10,0) ^9002313.9101^1^1^3180521^^^^ "DATA",9002313.91,575,10,1,0) S BPS("X")="" "DATA",9002313.91,575,20,0) ^9002313.9102^1^1^3180521^^^^ "DATA",9002313.91,575,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,575,25,0) ^9002313.9104^1^1^3180510^^ "DATA",9002313.91,575,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,575,30,0) ^9002313.9103^1^1^3180521^^^ "DATA",9002313.91,575,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C50"),U,10)=BPS("X") "DATA",9002313.91,576,0) C90^^LTPAC BILLING METHODOLOGY^N^^^^1^N "DATA",9002313.91,576,1) LTPAC BILLING METHODOLOGY "DATA",9002313.91,576,5) KH^1^2190^4 "DATA",9002313.91,576,10,0) ^9002313.9101^1^1^3180521^^ "DATA",9002313.91,576,10,1,0) S BPS("X")="" "DATA",9002313.91,576,20,0) ^9002313.9102^1^1^3180521^^ "DATA",9002313.91,576,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,576,25,0) ^^1^1^3180510^ "DATA",9002313.91,576,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,576,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,576,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C80"),U,10)=BPS("X") "DATA",9002313.91,577,0) C91^^LTPAC DISPENSE FREQUENCY^N^^^^2^N "DATA",9002313.91,577,1) LTPAC DISPENSE FREQUENCY "DATA",9002313.91,577,5) KK^2^2191^4 "DATA",9002313.91,577,10,0) ^9002313.9101^1^1^3180521^^^ "DATA",9002313.91,577,10,1,0) S BPS("X")="" "DATA",9002313.91,577,20,0) ^9002313.9102^1^1^3180521^^^ "DATA",9002313.91,577,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,577,25,0) ^9002313.9104^1^1^3180510^^ "DATA",9002313.91,577,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,577,30,0) ^9002313.9103^1^1^3180521^^^ "DATA",9002313.91,577,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C90"),U,1)=BPS("X") "DATA",9002313.91,578,0) C92^^NUMBER LTPAC DISPENSING EVENTS^N^^^^3^N "DATA",9002313.91,578,1) NUMBER OF LTPAC DISPENSING EVENTS "DATA",9002313.91,578,5) KM^3^2192^4 "DATA",9002313.91,578,10,0) ^9002313.9101^1^1^3180521^^ "DATA",9002313.91,578,10,1,0) S BPS("X")="" "DATA",9002313.91,578,20,0) ^9002313.9102^1^1^3180521^^ "DATA",9002313.91,578,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,578,25,0) ^^1^1^3180510^ "DATA",9002313.91,578,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,578,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,578,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C90"),U,2)=BPS("X") "DATA",9002313.91,579,0) C98^^PREPARATION ENVIRONMENT CODE^N^^^^3^N "DATA",9002313.91,579,1) PREPARATION ENVIRONMENT EVENT CODE "DATA",9002313.91,579,5) KT^3^2198^4 "DATA",9002313.91,579,10,0) ^9002313.9101^1^1^3180521^^ "DATA",9002313.91,579,10,1,0) S BPS("X")="" "DATA",9002313.91,579,20,0) ^9002313.9102^1^1^3180521^^ "DATA",9002313.91,579,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,579,25,0) ^^1^1^3180510^ "DATA",9002313.91,579,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3) "DATA",9002313.91,579,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,579,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C90"),U,8)=BPS("X") "DATA",9002313.91,580,0) C99^^PREPARATION ENVIRONMENT TYPE^A/N^^^^2^A/N "DATA",9002313.91,580,1) PREPARATION ENVIRONMENT TYPE "DATA",9002313.91,580,5) KU^2^2199^4 "DATA",9002313.91,580,10,0) ^9002313.9101^1^1^3180703^^^^ "DATA",9002313.91,580,10,1,0) S BPS("X")="" "DATA",9002313.91,580,20,0) ^9002313.9102^1^1^3180703^^^^ "DATA",9002313.91,580,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,580,25,0) ^9002313.9104^1^1^3180703^^^ "DATA",9002313.91,580,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2) "DATA",9002313.91,580,30,0) ^9002313.9103^1^1^3180703^^^^ "DATA",9002313.91,580,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C90"),U,9)=BPS("X") "DATA",9002313.91,581,0) D01^^PRESCRIBER DEA NUMBER^A/N^^^^15^A/N "DATA",9002313.91,581,1) PRESCRIBER DEA NUMBER "DATA",9002313.91,581,5) KV^15^2201^6 "DATA",9002313.91,581,10,0) ^^1^1^3180525^ "DATA",9002313.91,581,10,1,0) S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber DEA")) "DATA",9002313.91,581,20,0) ^9002313.9102^1^1^3180525^^^^ "DATA",9002313.91,581,20,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,581,25,0) ^9002313.9104^1^1^3180525^^^^ "DATA",9002313.91,581,25,1,0) S BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15) "DATA",9002313.91,581,30,0) ^^1^1^3180525^ "DATA",9002313.91,581,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D00"),U,1)=BPS("X") "DATA",9002313.91,582,0) D02^^TOTAL PRESCRIBED QTY REMAINING^N^^^^10^N "DATA",9002313.91,582,1) TOTAL PRESCRIBED QUANTITY REMAINING "DATA",9002313.91,582,5) KW^10^2202^4 "DATA",9002313.91,582,10,0) ^^1^1^3200602^ "DATA",9002313.91,582,10,1,0) ;Handled by FLDD02^BPSOSSG "DATA",9002313.91,582,20,0) ^9002313.9102^1^1^3180525^^^^ "DATA",9002313.91,582,20,1,0) ; Handled by FLDD02^BPSOSSG "DATA",9002313.91,582,25,0) ^9002313.9104^1^1^3180525^^^^ "DATA",9002313.91,582,25,1,0) ; Handled by FLDD02^BPSOSSG "DATA",9002313.91,582,30,0) ^9002313.9103^1^1^3180525^^ "DATA",9002313.91,582,30,1,0) D FLDD02^BPSOSSG "DATA",9002313.91,583,0) D14^^SUBROGATION AMOUNT REQUESTED^N^^^^9^N "DATA",9002313.91,583,1) SUBROGATION AMOUNT REQUESTED "DATA",9002313.91,583,5) KX^8^2214^10 "DATA",9002313.91,583,10,0) ^9002313.9101^1^1^3180521^^ "DATA",9002313.91,583,10,1,0) S BPS("X")="" "DATA",9002313.91,583,20,0) ^9002313.9102^1^1^3180521^^ "DATA",9002313.91,583,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,583,25,0) ^^1^1^3180510^ "DATA",9002313.91,583,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8) "DATA",9002313.91,583,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,583,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D10"),U,4)=BPS("X") "DATA",9002313.91,584,0) D16^^SUBMISSION TYPE CODE COUNT^N^^^^1^N "DATA",9002313.91,584,1) SUBMISSION TYPE CODE COUNT "DATA",9002313.91,584,5) KZ^1^2216^4 "DATA",9002313.91,584,10,0) ^9002313.9101^1^1^3180521^^ "DATA",9002313.91,584,10,1,0) S BPS("S")="" "DATA",9002313.91,584,20,0) ^9002313.9102^1^1^3180521^^ "DATA",9002313.91,584,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,584,25,0) ^^1^1^3180510^ "DATA",9002313.91,584,25,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,584,30,0) ^9002313.9103^1^1^3180521^^ "DATA",9002313.91,584,30,1,0) S $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D10"),U,6)=BPS("X") "DATA",9002313.91,585,0) C47^^OTHER PAYER PROGRAM TYPE^A/N^^^^3^A/N "DATA",9002313.91,585,1) OTHER PAYER ADJUDICATED PROGRAM TYPE "DATA",9002313.91,585,5) 9T^3^2147^7^31 "DATA",9002313.91,585,10,0) ^^1^1^3180807^ "DATA",9002313.91,585,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,586,0) C50^^BENEFIT STAGE INDICATOR COUNT^N^^^^1^N "DATA",9002313.91,586,1) BENEFITS STAGE INDICATOR COUNT "DATA",9002313.91,586,5) 9W^1^2150^7^28 "DATA",9002313.91,586,10,0) ^^1^1^3180807^ "DATA",9002313.91,586,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,587,0) C51^^BENEFIT STAGE INDICATOR^A/N^^^^2^A/N "DATA",9002313.91,587,1) BENEFITS STAGE INDICATOR "DATA",9002313.91,587,5) 9X^2^2151^7^28 "DATA",9002313.91,587,10,0) ^^1^1^3180807^ "DATA",9002313.91,587,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,588,0) D60^^REGULATORY FEE COUNT^N^^^^1^N "DATA",9002313.91,588,1) REGULATORY FEE COUNT "DATA",9002313.91,588,5) RK^1^2260^10^28 "DATA",9002313.91,588,10,0) ^^1^1^3180807^ "DATA",9002313.91,588,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,589,0) D61^^REGULATORY FEE TYPE CODE^A/N^^^^2^A/N "DATA",9002313.91,589,1) REGULATORY FEE TYPE CODE "DATA",9002313.91,589,5) RL^2^2261^10^28 "DATA",9002313.91,589,10,0) ^^1^1^3180807^ "DATA",9002313.91,589,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,590,0) 943^^MINIMUM AGE QUALIFIER^A/N^^^^1^A/N "DATA",9002313.91,590,1) MINIMUM AGE QUALIFIER "DATA",9002313.91,590,5) GQ^1^^^27 "DATA",9002313.91,590,10,0) ^^1^1^3180522^ "DATA",9002313.91,590,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,591,0) 944^^MINIMUM AGE^N^^^^3^N "DATA",9002313.91,591,1) MINIMUM AGE "DATA",9002313.91,591,5) GR^3^^^27 "DATA",9002313.91,591,10,0) ^^1^1^3180522^ "DATA",9002313.91,591,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,592,0) C86^^INTERMEDIARY HLPDSK TYP COUNT^N^^^^2^N "DATA",9002313.91,592,1) INTERMEDIARY HELP DESK SUPPORT TYPE COUNT "DATA",9002313.91,592,5) KC^2^2186^^32 "DATA",9002313.91,592,10,0) ^^1^1^3180522^ "DATA",9002313.91,592,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,595,0) E87^^INVALID PROVIDER DATA SOURCE^A/N^^^^2^A/N "DATA",9002313.91,595,1) DATA SOURCE OF INVALID PROVIDER DETERMINATION "DATA",9002313.91,595,5) ZV^2^2387^^34 "DATA",9002313.91,595,10,0) ^^1^1^3200429^ "DATA",9002313.91,595,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,596,0) E88^^INVALID PROVIDER SOURCE-STATE^A/N^^^^2^A/N "DATA",9002313.91,596,1) STATE CODE FOR DATA SOURCE OF INVALID PROVIDER DETERMINATION "DATA",9002313.91,596,5) ZZ^2^2388^^34 "DATA",9002313.91,596,10,0) ^^1^1^3200429^ "DATA",9002313.91,596,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,597,0) E89^^FORMULARY ALTERNATIVE EFF DATE^N^^^^8^N "DATA",9002313.91,597,1) FORMULARY ALTERNATIVE EFFECTIVE DATE "DATA",9002313.91,597,5) ZO^8^2389^^27 "DATA",9002313.91,597,10,0) ^9002313.9101^1^1^3200501^^ "DATA",9002313.91,597,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,598,0) E93^^DUR/DUE CO-AGENT DESCRIPTION^A/N^^^^40^A/N "DATA",9002313.91,598,1) "DATA",9002313.91,598,5) ZC^40^2393^^29 "DATA",9002313.91,598,10,0) ^^1^1^3200429^ "DATA",9002313.91,598,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,599,0) E94^^UNIT OF PRIOR DISPENSED QTY^A/N^^^^3^A/N "DATA",9002313.91,599,1) UNIT OF MEASURE FOR PREVIOUS DISPENSED QUANTITY "DATA",9002313.91,599,5) ZA^3^2394^^29 "DATA",9002313.91,599,10,0) ^^1^1^3200429^ "DATA",9002313.91,599,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,600,0) E95^^OTHER PHARMACY ID QUALIFIER^N^^^^2^N "DATA",9002313.91,600,1) "DATA",9002313.91,600,5) Z9^2^2395^^29 "DATA",9002313.91,600,10,0) ^^1^1^3200429^ "DATA",9002313.91,600,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,601,0) E96^^OTHER PHARMACY ID^A/N^^^^35^A/N "DATA",9002313.91,601,1) "DATA",9002313.91,601,5) Z8^35^2396^^29 "DATA",9002313.91,601,10,0) ^^1^1^3200429^ "DATA",9002313.91,601,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,602,0) E97^^OTHER PHARMACY NAME^A/N^^^^70^A/N "DATA",9002313.91,602,1) "DATA",9002313.91,602,5) Z7^70^2397^^29 "DATA",9002313.91,602,10,0) ^^1^1^3200429^ "DATA",9002313.91,602,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,603,0) E98^^OTHER PHARMACY TELEPHONE^N^^^^10^N "DATA",9002313.91,603,1) "DATA",9002313.91,603,5) Z6^10^2398^^29 "DATA",9002313.91,603,10,0) ^9002313.9101^1^1^3200501^^ "DATA",9002313.91,603,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,604,0) E99^^OTHER PRESCRIBER LAST NAME^A/N^^^^35^A/N "DATA",9002313.91,604,1) "DATA",9002313.91,604,5) Z5^35^2399^^29 "DATA",9002313.91,604,10,0) ^^1^1^3200429^ "DATA",9002313.91,604,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,605,0) F01^^OTHER PRESCRIBER ID QUALIFIER^A/N^^^^2^A/N "DATA",9002313.91,605,1) "DATA",9002313.91,605,5) Z4^2^2401^^9 "DATA",9002313.91,605,10,0) ^9002313.9101^1^1^3200501^^^^ "DATA",9002313.91,605,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,606,0) F02^^OTHER PRESCRIBER ID^A/N^^^^35^A/N "DATA",9002313.91,606,5) Z3^35^2402^^29 "DATA",9002313.91,606,10,0) ^9002313.9101^1^1^3200501^^^ "DATA",9002313.91,606,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,607,0) F03^^OTHER PRESCRIBER PHONE NUMBER^N^^^^10^N "DATA",9002313.91,607,1) OTHER PRESCRIBER TELEPHONE NUMBER "DATA",9002313.91,607,5) Z2^10^2403^^29 "DATA",9002313.91,607,10,0) ^9002313.9101^1^1^3200501^^ "DATA",9002313.91,607,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,608,0) F04^^DUR/DUE COMPOUND PRODUCT ID^A/N^^^^40^A/N "DATA",9002313.91,608,5) Z1^40^2404^^29 "DATA",9002313.91,608,10,0) ^9002313.9101^1^1^3200501^^ "DATA",9002313.91,608,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,609,0) F05^^DUR/DUE CMPND PRDUCT ID QUALIF^A/N^^^^2^A/N "DATA",9002313.91,609,1) DUR/DUE COMPOUND PRODUCT ID QUALIFIER "DATA",9002313.91,609,5) Z0^2^2405^^29 "DATA",9002313.91,609,10,0) ^^1^1^3200429^ "DATA",9002313.91,609,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,610,0) F06^^DUR/DUE MAXIMUM DAILY DOSE QTY^N^^^^10^N "DATA",9002313.91,610,1) DUR/DUE MAXIMUM DAILY DOSE QUANTITY "DATA",9002313.91,610,5) YO^10^2406^^29 "DATA",9002313.91,610,10,0) ^^1^1^3200429^ "DATA",9002313.91,610,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,611,0) F07^^DUR/DUE MAX DAILY DOSE - UNIT^A/N^^^^3^A/N "DATA",9002313.91,611,1) DUR/DUE MAXIMUM DAILY DOSE UNIT OF MEASURE "DATA",9002313.91,611,5) YL^3^2407^^29 "DATA",9002313.91,611,10,0) ^^1^1^3200429^ "DATA",9002313.91,611,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,612,0) F08^^DUR/DUE MINIMUM DAILY DOSE QTY^N^^^^10^N "DATA",9002313.91,612,1) DUR/DUE MINIMUM DAILY DOSE QUANTITY "DATA",9002313.91,612,5) YJ^10^2408^^29 "DATA",9002313.91,612,10,0) ^^1^1^3200429^ "DATA",9002313.91,612,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,613,0) F09^^DUR/DUE MIN DAILY DOSE - UNIT^A/N^^^^3^A/N "DATA",9002313.91,613,1) DUR/DUE MINIMUM DAILY DOSE UNIT OF MEASURE "DATA",9002313.91,613,5) YI^3^2409^^29 "DATA",9002313.91,613,10,0) ^^1^1^3200429^ "DATA",9002313.91,613,10,1,0) ; This is a response-only field which does not use the GET, FORMAT, or SET code "DATA",9002313.91,615,0) F32^^SEX ASSIGNED AT BIRTH^N^^^^1^N "DATA",9002313.91,615,5) W8^1^2432^2 "DATA",9002313.91,615,10,0) ^^1^1^3210930^ "DATA",9002313.91,615,10,1,0) S BPS("X")="" "DATA",9002313.91,615,20,0) ^^1^1^3210930^ "DATA",9002313.91,615,20,1,0) S BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1) "DATA",9002313.91,615,30,0) ^^1^1^3210930^ "DATA",9002313.91,615,30,1,0) S $P(^BPSC(BPS(9002313.02),"F30"),U,2)=BPS("X") "FIA",9002313.02) BPS CLAIMS "FIA",9002313.02,0) ^BPSC( "FIA",9002313.02,0,0) 9002313.02 "FIA",9002313.02,0,1) y^y^f^^^^n "FIA",9002313.02,0,10) "FIA",9002313.02,0,11) "FIA",9002313.02,0,"RLRO") "FIA",9002313.02,0,"VR") 1.0^BPS "FIA",9002313.02,9002313.02) 0 "FIA",9002313.02,9002313.0201) 0 "FIA",9002313.02,9002313.022044) 0 "FIA",9002313.02,9002313.02354) 0 "FIA",9002313.02,9002313.023771) 0 "FIA",9002313.02,9002313.0401) 0 "FIA",9002313.02,9002313.0501) 0 "FIA",9002313.02,9002313.05011) 0 "FIA",9002313.02,9002313.0601) 0 "FIA",9002313.02,9002313.0701) 0 "FIA",9002313.02,9002313.0801) 0 "FIA",9002313.02,9002313.0901) 0 "FIA",9002313.02,9002313.1001) 0 "FIA",9002313.02,9002313.201459) 0 "FIA",9002313.02,9002313.29999) 0 "FIA",9002313.02,9002313.401342) 0 "FIA",9002313.02,9002313.401353) 0 "FIA",9002313.02,9002313.401392) 0 "FIA",9002313.02,9002313.401472) 0 "FIA",9002313.91) BPS NCPDP FIELD DEFS "FIA",9002313.91,0) ^BPSF(9002313.91, "FIA",9002313.91,0,0) 9002313.91I "FIA",9002313.91,0,1) y^y^f^^n^^y^o^n "FIA",9002313.91,0,10) "FIA",9002313.91,0,11) "FIA",9002313.91,0,"RLRO") "FIA",9002313.91,0,"VR") 1.0^BPS "FIA",9002313.91,9002313.91) 0 "FIA",9002313.91,9002313.9101) 0 "FIA",9002313.91,9002313.9102) 0 "FIA",9002313.91,9002313.9103) 0 "FIA",9002313.91,9002313.9104) 0 "IX",9002313.02,9002313.02,"AC",0) 9002313.02^AC^MCCF EDI TAS Progress^MU^^F^IR^I^9002313.02^^^^^A "IX",9002313.02,9002313.02,"AC",1) D CLOSE^BPSRPC03(.DA) "IX",9002313.02,9002313.02,"AC",2) D CLOSE^BPSRPC03(.DA) "IX",9002313.02,9002313.02,"AC",2.5) Q "IX",9002313.02,9002313.02,"AC",11.1,0) ^.114IA^1^1 "IX",9002313.02,9002313.02,"AC",11.1,1,0) 1^F^9002313.02^901^^^F "IX",9002313.02,9002313.02,"AC",11.1,1,3) "MBREQ") 1 "PKG",632,-1) 1^1 "PKG",632,0) E CLAIMS MGMT ENGINE^BPS^ELECTRONIC CLAIMS MGT "PKG",632,22,0) ^9.49I^1^1 "PKG",632,22,1,0) 1.0^3041008^3041130^568 "PKG",632,22,1,"PAH",1,0) 32^3220613 "QUES","XPF1",0) Y "QUES","XPF1","??") ^D REP^XPDH "QUES","XPF1","A") Shall I write over your |FLAG| File "QUES","XPF1","B") YES "QUES","XPF1","M") D XPF1^XPDIQ "QUES","XPF2",0) Y "QUES","XPF2","??") ^D DTA^XPDH "QUES","XPF2","A") Want my data |FLAG| yours "QUES","XPF2","B") YES "QUES","XPF2","M") D XPF2^XPDIQ "QUES","XPI1",0) YO "QUES","XPI1","??") ^D INHIBIT^XPDH "QUES","XPI1","A") Want KIDS to INHIBIT LOGONs during the install "QUES","XPI1","B") NO "QUES","XPI1","M") D XPI1^XPDIQ "QUES","XPM1",0) PO^VA(200,:EM "QUES","XPM1","??") ^D MG^XPDH "QUES","XPM1","A") Enter the Coordinator for Mail Group '|FLAG|' "QUES","XPM1","B") "QUES","XPM1","M") D XPM1^XPDIQ "QUES","XPO1",0) Y "QUES","XPO1","??") ^D MENU^XPDH "QUES","XPO1","A") Want KIDS to Rebuild Menu Trees Upon Completion of Install "QUES","XPO1","B") NO "QUES","XPO1","M") D XPO1^XPDIQ "QUES","XPZ1",0) Y "QUES","XPZ1","??") ^D OPT^XPDH "QUES","XPZ1","A") Want to DISABLE Scheduled Options, Menu Options, and Protocols "QUES","XPZ1","B") NO "QUES","XPZ1","M") D XPZ1^XPDIQ "QUES","XPZ2",0) Y "QUES","XPZ2","??") ^D RTN^XPDH "QUES","XPZ2","A") Want to MOVE routines to other CPUs "QUES","XPZ2","B") NO "QUES","XPZ2","M") D XPZ2^XPDIQ "RTN") 3 "RTN","BPSOSCC") 0^1^B30984593 "RTN","BPSOSCC",1,0) BPSOSCC ;BHAM ISC/FCS/DRS/DLF - Set up BPS() ;06/01/2004 "RTN","BPSOSCC",2,0) ;;1.0;E CLAIMS MGMT ENGINE;**1,2,5,8,10,11,19,27,32**;JUN 2004;Build 15 "RTN","BPSOSCC",3,0) ;;Per VA Directive 6402, this routine should not be modified. "RTN","BPSOSCC",4,0) ; "RTN","BPSOSCC",5,0) ; GETINFO - Create BPS array for non-repeating data "RTN","BPSOSCC",6,0) ; IEN59 - Pointer to BPS Transactions "RTN","BPSOSCC",7,0) ; IEN5902 - IEN for Insurance multiple of BPS Transactions "RTN","BPSOSCC",8,0) ; "RTN","BPSOSCC",9,0) ; BPS array is shared by all of the BPSOSC* routines, created in BPSOSCA "RTN","BPSOSCC",10,0) ; VAINFO is created in BPSOSCB "RTN","BPSOSCC",11,0) Q "RTN","BPSOSCC",12,0) ; "RTN","BPSOSCC",13,0) GETINFO(IEN59,IEN5902) ; EP - BPSOSCB "RTN","BPSOSCC",14,0) ; both parameters required "RTN","BPSOSCC",15,0) Q:$G(IEN59)="" "RTN","BPSOSCC",16,0) Q:$G(IEN5902)="" "RTN","BPSOSCC",17,0) ; "RTN","BPSOSCC",18,0) N BPPAYSEQ,BPSSEX,BPSSIG,DFN,IENS,NPI,SITE,VADM,VAPA,X "RTN","BPSOSCC",19,0) ; "RTN","BPSOSCC",20,0) S BPPAYSEQ=$$COB59^BPSUTIL2(IEN59) ; COB payer sequence "RTN","BPSOSCC",21,0) ; Setup IENS for transaction multiple "RTN","BPSOSCC",22,0) S IENS=IEN5902_","_IEN59_"," "RTN","BPSOSCC",23,0) ; Site Information "RTN","BPSOSCC",24,0) S SITE=$P($G(^BPST(IEN59,1)),U,4) "RTN","BPSOSCC",25,0) S NPI=$$NPI^BPSNPI("Pharmacy_ID",SITE) "RTN","BPSOSCC",26,0) I +NPI=-1 S NPI="" "RTN","BPSOSCC",27,0) S BPS("Site","NPI")=$P(NPI,U) "RTN","BPSOSCC",28,0) ; "RTN","BPSOSCC",29,0) ; Get Transaction Code "RTN","BPSOSCC",30,0) S BPS("Transaction Code")=$S($P($G(^BPST(IEN59,0)),U,15)="E":"E1",1:"B1") "RTN","BPSOSCC",31,0) ; "RTN","BPSOSCC",32,0) ; Transaction Header Data "RTN","BPSOSCC",33,0) S BPS("NCPDP","IEN")=$G(VAINFO(9002313.59902,IENS,$S(BPS("Transaction Code")="E1":902.34,1:902.02),"I")) "RTN","BPSOSCC",34,0) S BPS("NCPDP","BIN Number")=$G(VAINFO(9002313.59902,IENS,902.03,"I")) "RTN","BPSOSCC",35,0) S BPS("NCPDP","PCN")=$G(VAINFO(9002313.59902,IENS,902.04,"I")) "RTN","BPSOSCC",36,0) S BPS("NCPDP","Software Vendor/Cert ID")=$G(VAINFO(9002313.59902,IENS,902.18,"I")) "RTN","BPSOSCC",37,0) I BPS("NCPDP","IEN")="" D IMPOSS^BPSOSUE("P","TI","Payer Sheet pointer missing from multiple",,1,$T(+0)) "RTN","BPSOSCC",38,0) I BPS("NCPDP","IEN") S BPS("NCPDP","Version")=$P($G(^BPSF(9002313.92,BPS("NCPDP","IEN"),1)),U,2) "RTN","BPSOSCC",39,0) I $G(BPS("NCPDP","Version"))="" D IMPOSS^BPSOSUE("DB","TI","Payer sheet version missing.",,2,$T(+0)) "RTN","BPSOSCC",40,0) S BPS("NCPDP","# Meds/Claim")=$G(VAINFO(9002313.59902,IENS,902.32,"I")) "RTN","BPSOSCC",41,0) I BPS("Transaction Code")="E1"!('BPS("NCPDP","# Meds/Claim")) S BPS("NCPDP","# Meds/Claim")=1 "RTN","BPSOSCC",42,0) S BPS("NCPDP","DOS")=$$FMTHL7^XLFDT($P($G(^BPST(IEN59,12)),U,2)) "RTN","BPSOSCC",43,0) ; "RTN","BPSOSCC",44,0) ; Patient Data "RTN","BPSOSCC",45,0) S DFN=$P(^BPST(IEN59,0),U,6) "RTN","BPSOSCC",46,0) I 'DFN D IMPOSS^BPSOSUE("DB","TI","DFN",,,$T(+0)) "RTN","BPSOSCC",47,0) I DFN,'$D(^DPT(DFN,0)) D IMPOSS^BPSOSUE("DB","TI","^DPT(DFN)",,,$T(+0)) "RTN","BPSOSCC",48,0) D DEM^VADPT,ADD^VADPT "RTN","BPSOSCC",49,0) S BPS("Patient","IEN")=DFN "RTN","BPSOSCC",50,0) S (X,BPS("Patient","Name"))=$G(VADM(1)) "RTN","BPSOSCC",51,0) D SETNAME^PSOSPMUT(DFN) "RTN","BPSOSCC",52,0) S BPS("Patient","Last Name")=$G(PSONAME("LAST")) "RTN","BPSOSCC",53,0) S BPS("Patient","First Name")=$G(PSONAME("FIRST")) "RTN","BPSOSCC",54,0) S BPS("Patient","Middle Name")=$G(PSONAME("MIDDLE")) "RTN","BPSOSCC",55,0) S BPS("Patient","Prefix")=$G(PSONAME("PREFIX")) "RTN","BPSOSCC",56,0) S BPS("Patient","Suffix")=$G(PSONAME("SUFFIX")) "RTN","BPSOSCC",57,0) S BPSSEX=$P($G(VADM(5)),"^",1) ; SEX, field# .02 "RTN","BPSOSCC",58,0) S BPSSIG=$P($G(VADM(14,5)),"^",2) ; SELF IDENTIFIED GENDER, field# .024 "RTN","BPSOSCC",59,0) I BPSSIG'="" S BPS("Patient","Gender Code")=$S(BPSSIG="M":1,BPSSIG="F":2,BPSSIG="N":0,1:3) "RTN","BPSOSCC",60,0) E S BPS("Patient","Gender Code")=$S(BPSSEX="M":1,BPSSEX="F":2,1:0) "RTN","BPSOSCC",61,0) S X=$P($G(VADM(3)),"^") ; date of birth, FM format "RTN","BPSOSCC",62,0) S BPS("Patient","DOB")=($E(X,1,3)+1700)_$E(X,4,7) "RTN","BPSOSCC",63,0) S BPS("Patient","SSN")=$P($G(VADM(2)),"^",1) "RTN","BPSOSCC",64,0) S BPS("Patient","State")=$P($G(VAPA(5)),"^",1) "RTN","BPSOSCC",65,0) I BPS("Patient","State")'="" S BPS("Patient","State")=$P($G(^DIC(5,BPS("Patient","State"),0)),"^",2) "RTN","BPSOSCC",66,0) S BPS("Patient","Street Address")=$G(VAPA(1)) "RTN","BPSOSCC",67,0) S BPS("Patient","Street Address Line 1")=$G(VAPA(1)) "RTN","BPSOSCC",68,0) S BPS("Patient","Street Address Line 2")=$G(VAPA(2)) "RTN","BPSOSCC",69,0) S BPS("Patient","City")=$G(VAPA(4)) "RTN","BPSOSCC",70,0) S BPS("Patient","Zip")=$G(VAPA(6)) "RTN","BPSOSCC",71,0) S BPS("Patient","Phone #")=$TR($P($G(VAPA(8)),"^",1),"()-/*# ") "RTN","BPSOSCC",72,0) S BPS("Patient","Place of Service")=$S($G(BPS("NCPDP","Version"))=51:0,1:1) ; NCPDP field 307-C7 default to 1 for vD.0 "RTN","BPSOSCC",73,0) S BPS("Patient","Patient Residence")=1 ; NCPDP field 384-4X, 1 for "Home" "RTN","BPSOSCC",74,0) S BPS("Patient","Patient E-Mail Address")=$$GET1^DIQ(2,DFN,.133) ; NCPDP field 350-HN "RTN","BPSOSCC",75,0) ; "RTN","BPSOSCC",76,0) ; Insurer Data "RTN","BPSOSCC",77,0) S BPS("Insurer","IEN")=$G(VAINFO(9002313.59902,IENS,.01,"I")) "RTN","BPSOSCC",78,0) S BPS("Patient","Primary Care Prov Location Code")=$G(VAINFO(9002313.59902,IENS,902.11,"I")) "RTN","BPSOSCC",79,0) S BPS("Insurer","Relationship")=$G(VAINFO(9002313.59902,IENS,902.07,"I")) "RTN","BPSOSCC",80,0) S:BPS("Insurer","Relationship")="" BPS("Insurer","Relationship")=0 ; if null set to unspecified "RTN","BPSOSCC",81,0) S BPS("Insurer","Person Code")=$G(VAINFO(9002313.59902,IENS,902.1,"I")) "RTN","BPSOSCC",82,0) ; "RTN","BPSOSCC",83,0) ; If 303-C3 Person Code has no value from patient insurance policy field, then continue to "RTN","BPSOSCC",84,0) ; calculate the value based upon the 306-C6 Patient Relationship Code field "RTN","BPSOSCC",85,0) I BPS("Insurer","Person Code")="" D "RTN","BPSOSCC",86,0) . N REL S REL=BPS("Insurer","Relationship") "RTN","BPSOSCC",87,0) . S BPS("Insurer","Person Code")=$S(REL=1:"01",REL=2:"02",REL=3:"03",1:"") "RTN","BPSOSCC",88,0) . Q "RTN","BPSOSCC",89,0) ; "RTN","BPSOSCC",90,0) S BPS("Insurer","Plan ID")=$G(VAINFO(9002313.59902,IENS,902.24,"I")) "RTN","BPSOSCC",91,0) S BPS("Insurer","Group #")=$G(VAINFO(9002313.59902,IENS,902.05,"I")) "RTN","BPSOSCC",92,0) S BPS("Insurer","Policy #")=$G(VAINFO(9002313.59902,IENS,902.06,"I")) ;CARDHOLDER ID "RTN","BPSOSCC",93,0) S BPS("Insurer","Full Policy #")=BPS("Insurer","Policy #") "RTN","BPSOSCC",94,0) S BPS("Insurer","Percent Sales Tax Rate Sub")="" ; 483-HE Percentage Sales Tax Rate Submitted "RTN","BPSOSCC",95,0) S BPS("Insurer","Percent Sales Tax Basis Sub")="" ; 484-JE Percentage Sales Tax Basis Submitted "RTN","BPSOSCC",96,0) S BPS("Insurer","Percentage Sales Tax Amt Sub")=0 ; 482-GE Percentage Sales Tax Amount Submitted "RTN","BPSOSCC",97,0) S BPS("Insurer","Flat Sales Tax Amount Sub")=0 ; 481-HA Flat Sales Tax Amount Submitted "RTN","BPSOSCC",98,0) ; "RTN","BPSOSCC",99,0) ; Cardholder Data "RTN","BPSOSCC",100,0) S BPS("Cardholder","First Name")=$G(VAINFO(9002313.59902,IENS,902.08,"I")) "RTN","BPSOSCC",101,0) S BPS("Cardholder","Last Name")=$G(VAINFO(9002313.59902,IENS,902.09,"I")) "RTN","BPSOSCC",102,0) S BPS("Home Plan")=$G(VAINFO(9002313.59902,IENS,902.11,"I")) "RTN","BPSOSCC",103,0) ; "RTN","BPSOSCC",104,0) ; set additional fields for secondary claim "RTN","BPSOSCC",105,0) S:BPPAYSEQ>1 BPS("Patient","Other Coverage Code")=$P($G(^BPST(IEN59,12)),U,5) ; NCPDP field 308-C8 Other Coverage Code "RTN","BPSOSCC",106,0) ; "RTN","BPSOSCC",107,0) Q "RTN","BPSOSCC",108,0) ; "RTN","BPSRES") 0^2^B220162120 "RTN","BPSRES",1,0) BPSRES ;BHAM ISC/BEE - ECME SCREEN RESUBMIT W/EDITS ;3/12/08 14:01 "RTN","BPSRES",2,0) ;;1.0;E CLAIMS MGMT ENGINE;**3,5,7,8,10,11,20,21,23,24,30,32**;JUN 2004;Build 15 "RTN","BPSRES",3,0) ;;Per VA Directive 6402, this routine should not be modified. "RTN","BPSRES",4,0) ; "RTN","BPSRES",5,0) ; Reference to $$RXRLDT^PSOBPSUT in ICR #4701 "RTN","BPSRES",6,0) ; Reference to $$RXFLDT^PSOBPSUT in ICR #4701 "RTN","BPSRES",7,0) ; Reference to $$FIND^PSOREJUT in ICR #4706 "RTN","BPSRES",8,0) ; Reference to GET^PSOREJU2 in ICR #6749 "RTN","BPSRES",9,0) ; "RTN","BPSRES",10,0) ;ECME Resubmit w/EDITS Protocol (Hidden) - Called by [BPS USER SCREEN] "RTN","BPSRES",11,0) ; "RTN","BPSRES",12,0) RESED N BPSEL "RTN","BPSRES",13,0) ; "RTN","BPSRES",14,0) I '$D(@(VALMAR)) G XRESED "RTN","BPSRES",15,0) D FULL^VALM1 "RTN","BPSRES",16,0) ; "RTN","BPSRES",17,0) ; Select the claim to resubmit "RTN","BPSRES",18,0) ; "RTN","BPSRES",19,0) W !,"Enter the line number for the claim to be resubmitted." "RTN","BPSRES",20,0) S BPSEL=$$ASKLINE("Select item","Please select a SINGLE claim only when using the Resubmit w/EDITS action option.") "RTN","BPSRES",21,0) I BPSEL<1 S VALMBCK="R" G XRESED "RTN","BPSRES",22,0) ; "RTN","BPSRES",23,0) ; Attempt to resubmit the claim, update the content of the screen, "RTN","BPSRES",24,0) ; and display only if claim submitted successfully "RTN","BPSRES",25,0) ; "RTN","BPSRES",26,0) I $$DOSELCTD(BPSEL) D REDRAW^BPSSCRUD("Updating screen for resubmitted claim...") "RTN","BPSRES",27,0) E S VALMBCK="R" "RTN","BPSRES",28,0) ; "RTN","BPSRES",29,0) XRESED Q "RTN","BPSRES",30,0) ; "RTN","BPSRES",31,0) ; Attempt to Edit and Resubmit Selected Claim "RTN","BPSRES",32,0) ; "RTN","BPSRES",33,0) ; Input Value -> BPRXI - Entry with ptr to BPS TRANSACTION file "RTN","BPSRES",34,0) ; "RTN","BPSRES",35,0) ; Return Value -> 0 - Claim was not resubmitted "RTN","BPSRES",36,0) ; 1 - Claim was resubmitted "RTN","BPSRES",37,0) ; "RTN","BPSRES",38,0) DOSELCTD(BPRXI) ; "RTN","BPSRES",39,0) N BP02,BP59,BPADDLTXT,BPBILL,BPCLTOT,BPDFN,BPDOSDT,BPOVRIEN,BPQ,BPRXIEN,BPRXR,BPSTATUS,BPUPDFLG "RTN","BPSRES",40,0) N BPCOB,BPSURE,BPPTRES,BPPHSRV,BPDLYRS,COBDATA,BPPRIOPN,BPSPCLS,BPMSG "RTN","BPSRES",41,0) S BPQ="" "RTN","BPSRES",42,0) S BPADDLTXT="" "RTN","BPSRES",43,0) S (BPCLTOT,BPUPDFLG)=0 "RTN","BPSRES",44,0) ; "RTN","BPSRES",45,0) ; Pull BPS TRANSACTION/BPS CLAIMS entries "RTN","BPSRES",46,0) ; "RTN","BPSRES",47,0) S BP59=$P(BPRXI,U,4) I BP59="" W !!,"No Initial Claim Submission Found - Data Elements are NOT Editable for Re-Submission",! G XRES "RTN","BPSRES",48,0) ; "RTN","BPSRES",49,0) ; Check for non-billable entry "RTN","BPSRES",50,0) ; "RTN","BPSRES",51,0) I $$NB^BPSSCR03(BP59) W !!,"Entry is NON BILLABLE. There is no claim to edit or resubmit.",! G XRES "RTN","BPSRES",52,0) ; "RTN","BPSRES",53,0) S BP02=+$P($G(^BPST(BP59,0)),U,4) I 'BP02 W !!,"No Initial Claim Submission Found - Data Elements are NOT Editable for Re-Submission",! G XRES "RTN","BPSRES",54,0) ; "RTN","BPSRES",55,0) ; Display selected claim and ask to submit "RTN","BPSRES",56,0) ; "RTN","BPSRES",57,0) W @IOF ; Form feed "RTN","BPSRES",58,0) S BPDFN=+$P($G(^BPST(BP59,0)),U,6) "RTN","BPSRES",59,0) W !,"You've chosen to RESUBMIT the following prescription for "_$E($$PATNAME^BPSSCRU2(BPDFN),1,13) "RTN","BPSRES",60,0) W !,@VALMAR@(+$P(BPRXI,U,5),0) "RTN","BPSRES",61,0) S BPQ=$$YESNO^BPSSCRRS("Are you sure(Y/N)") "RTN","BPSRES",62,0) I BPQ'=1 S BPQ="^" G XRES "RTN","BPSRES",63,0) ; "RTN","BPSRES",64,0) ; Check to make sure claim can be Resubmitted w/EDITS "RTN","BPSRES",65,0) ; "RTN","BPSRES",66,0) S BPRXIEN=$P(BP59,".") "RTN","BPSRES",67,0) S BPRXR=+$E($P(BP59,".",2),1,4) "RTN","BPSRES",68,0) I $$RXDEL^BPSOS($P(BP59,".",1),+$E($P(BP59,".",2),1,4)) W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"cannot be Resubmitted w/EDITS because it has been deleted in Pharmacy.",! G XRES "RTN","BPSRES",69,0) S BPSTATUS=$P($$CLAIMST^BPSSCRU3(BP59),U) "RTN","BPSRES",70,0) I BPSTATUS["IN PROGRESS" W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"is still In Progress and cannot be Resubmitted w/EDITS",! G XRES "RTN","BPSRES",71,0) I BPSTATUS'["E REJECTED" W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"is NOT Rejected and cannot be Resubmitted w/EDITS",! G XRES "RTN","BPSRES",72,0) I $P($G(^BPST(BP59,0)),U,14)<2,$$PAYABLE^BPSOSRX5(BPSTATUS),$$PAYBLSEC^BPSUTIL2(BP59) D G XRES "RTN","BPSRES",73,0) . W !,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"cannot be Resubmitted if the secondary claim is payable.",!,"Please reverse the secondary claim first." "RTN","BPSRES",74,0) ; "RTN","BPSRES",75,0) ; Can't resubmit a closed claim. The user must reopen first. "RTN","BPSRES",76,0) ; "RTN","BPSRES",77,0) I $$CLOSED^BPSSCRU1(BP59) W !!,"The claim: ",!,@VALMAR@(+$P(BPRXI,U,5),0),!,"is Closed and cannot be Resubmitted w/EDITS.",! G XRES "RTN","BPSRES",78,0) ; "RTN","BPSRES",79,0) ; If this is a secondary, make sure Primary is either Payable or Closed. "RTN","BPSRES",80,0) ; "RTN","BPSRES",81,0) S BPPRIOPN=0 "RTN","BPSRES",82,0) S BPCOB=$$COB59^BPSUTIL2(BP59) "RTN","BPSRES",83,0) I BPCOB=2 D G XRES:BPPRIOPN=1 "RTN","BPSRES",84,0) . ; Get Primary claim status "RTN","BPSRES",85,0) . S BPSPCLS=$$FINDECLM^BPSPRRX5(BPRXIEN,BPRXR,1) "RTN","BPSRES",86,0) . I $P(BPSPCLS,U)>1 D "RTN","BPSRES",87,0) .. Q:$$CLOSED^BPSSCRU1($P(BPSPCLS,U,2)) "RTN","BPSRES",88,0) .. W !,"The secondary claim cannot be Resubmitted unless the primary is either payable",!,"or closed. Please resubmit or close the primary claim first." "RTN","BPSRES",89,0) .. S BPPRIOPN=1 "RTN","BPSRES",90,0) ; Retrieve DOS "RTN","BPSRES",91,0) S BPDOSDT=$$DOSDATE^BPSSCRRS(BPRXIEN,BPRXR) "RTN","BPSRES",92,0) ; "RTN","BPSRES",93,0) ; Prompt for EDIT Information "RTN","BPSRES",94,0) ; "RTN","BPSRES",95,0) S BPOVRIEN=$$PROMPTS(BP59,BP02,BPRXIEN,BPRXR,BPCOB,.BPDOSDT,.COBDATA,.BPADDLTXT) I BPOVRIEN=-1 G XRES "RTN","BPSRES",96,0) ; "RTN","BPSRES",97,0) ; Submit the claim "RTN","BPSRES",98,0) ; "RTN","BPSRES",99,0) S BPBILL=$$EN^BPSNCPDP(BPRXIEN,BPRXR,BPDOSDT,"ERES","","ECME RESUBMIT","",BPOVRIEN,"","",BPCOB,"F","","",$G(COBDATA("PLAN")),.COBDATA,$G(COBDATA("RTYPE"))) "RTN","BPSRES",100,0) ; "RTN","BPSRES",101,0) ; Print Return Value Message. Change Return Message for SC/EI. "RTN","BPSRES",102,0) ; "RTN","BPSRES",103,0) W !! "RTN","BPSRES",104,0) I +BPBILL>0 W $S(+BPBILL=10:"Reversal but no Resubmit:",1:"Not Processed:"),!," " "RTN","BPSRES",105,0) I $P(BPBILL,U,2)="NEEDS SC DETERMINATION" S $P(BPBILL,U,2)="NEEDS SC/EI DETERMINATION" "RTN","BPSRES",106,0) W $P(BPBILL,U,2) "RTN","BPSRES",107,0) ; "RTN","BPSRES",108,0) ;0 Prescription/Fill successfully submitted to ECME "RTN","BPSRES",109,0) ;1 ECME did not submit prescription/fill "RTN","BPSRES",110,0) ;2 IB says prescription/fill is not ECME billable or the data returned from IB is not valid "RTN","BPSRES",111,0) ;3 ECME closed the claim but did not submit it to the payer "RTN","BPSRES",112,0) ;4 Unable to queue the ECME claim "RTN","BPSRES",113,0) ;5 Invalid input "RTN","BPSRES",114,0) ;10 Reversal Processed But Claim Was Not Resubmitted "RTN","BPSRES",115,0) ; "RTN","BPSRES",116,0) I +BPBILL=0 D "RTN","BPSRES",117,0) . S BPMSG="ECME RED Resubmit Claim w/Edits" "RTN","BPSRES",118,0) . I BPADDLTXT'="" S BPMSG=BPMSG_": "_BPADDLTXT "RTN","BPSRES",119,0) . S BPMSG=BPMSG_"-"_$S(BPCOB=1:"p",BPCOB=2:"s",1:"")_$$INSNAME^BPSSCRU6(BP59) "RTN","BPSRES",120,0) . S BPMSG=$E(BPMSG,1,100) "RTN","BPSRES",121,0) . D ECMEACT^PSOBPSU1(+BPRXIEN,+BPRXR,BPMSG) "RTN","BPSRES",122,0) . S BPUPDFLG=1,BPCLTOT=1 "RTN","BPSRES",123,0) ; "RTN","BPSRES",124,0) XRES ; "RTN","BPSRES",125,0) I BPCLTOT W !,BPCLTOT," claim",$S(BPCLTOT'=1:"s have",1:" has")," been resubmitted.",! "RTN","BPSRES",126,0) D PAUSE^VALM1 "RTN","BPSRES",127,0) Q BPUPDFLG "RTN","BPSRES",128,0) ; "RTN","BPSRES",129,0) XRES2 ; "RTN","BPSRES",130,0) I BPCLTOT W !,BPCLTOT," claim",$S(BPCLTOT'=1:"s have",1:" has")," been resubmitted.",! "RTN","BPSRES",131,0) Q BPUPDFLG "RTN","BPSRES",132,0) ; "RTN","BPSRES",133,0) ;Enter EDIT information for claim "RTN","BPSRES",134,0) ; "RTN","BPSRES",135,0) ; Input Values -> BP59 - The BPS TRANSACTION entry "RTN","BPSRES",136,0) ; BP02 - The BPS CLAIMS entry "RTN","BPSRES",137,0) ; BPRXIEN - Prescription IEN (#52) "RTN","BPSRES",138,0) ; BPRXR - Fill Number "RTN","BPSRES",139,0) ; BPCOB - (optional) payer sequence (1-primary, 2 -secondary) "RTN","BPSRES",140,0) ; BPDOSDT - Date of Service, passed by reference "RTN","BPSRES",141,0) ; BPSECOND - Array, passed by reference, of COB data "RTN","BPSRES",142,0) ; BPADDLTXT - Passed by reference, text to add to ECME "RTN","BPSRES",143,0) ; log if user chooses to use Date of Service on the "RTN","BPSRES",144,0) ; claim instead of the Release Date. "RTN","BPSRES",145,0) ; Output Value -> BPQ - -1 - The user chose to quit "RTN","BPSRES",146,0) ; "" - The user completed the EDITS "RTN","BPSRES",147,0) PROMPTS(BP59,BP02,BPRXIEN,BPRXR,BPCOB,BPDOSDT,BPSECOND,BPADDLTXT) ; "RTN","BPSRES",148,0) N %,BP300,BP35401,BPCLCD1,BPCLCD2,BPCLCD3,BPFDA,BPFLD,BPOVRIEN,BPMED,BPPSNCD "RTN","BPSRES",149,0) N BPPREAUT,BPPRETYP,BPQ,BPRELCD,BPRELEASEDT,DIC,DIR,DIROUT,DTOUT,DUOUT,X,Y,DIRUT,DUP "RTN","BPSRES",150,0) N BPCLCDN,BPCLCDX,BPSX,BPSADDLFLDS,BPDFN,BPGENDER,BPSEX,BPSIG "RTN","BPSRES",151,0) S BPQ="" "RTN","BPSRES",152,0) I +$G(BPCOB)=0 S BPCOB=1 "RTN","BPSRES",153,0) ; "RTN","BPSRES",154,0) ; Pull Information from Claim "RTN","BPSRES",155,0) ; "RTN","BPSRES",156,0) S BP300=$G(^BPSC(BP02,300)) "RTN","BPSRES",157,0) S BPRELCD=$TR($E($P(BP300,U,6),3,99)," ") "RTN","BPSRES",158,0) S BPPSNCD=$TR($E($P(BP300,U,3),3,99)," ") "RTN","BPSRES",159,0) S (BPPRETYP,BPPREAUT,BPDLYRS,BPPHSRV)="" "RTN","BPSRES",160,0) S BPMED=0 "RTN","BPSRES",161,0) F S BPMED=$O(^BPSC(BP02,400,BPMED)) Q:'BPMED D I BPPREAUT]"" Q "RTN","BPSRES",162,0) . N BP460 "RTN","BPSRES",163,0) . S BP460=$G(^BPSC(BP02,400,BPMED,460)) "RTN","BPSRES",164,0) . I BPPREAUT="" S BPPREAUT=$TR($E($P(BP460,U,2),3,99)," "),BPPRETYP=$TR($E($P(BP460,U),3,99)," ") "RTN","BPSRES",165,0) . I BPDLYRS="" S BPDLYRS=$TR($E($P($G(^BPSC(BP02,400,BPMED,350)),U,7),3,99)," ") "RTN","BPSRES",166,0) . I BPDLYRS]"" S BPDLYRS=+BPDLYRS "RTN","BPSRES",167,0) . I BPPHSRV="" S BPPHSRV=$TR($E($P($G(^BPSC(BP02,400,BPMED,140)),U,7),3,99)," ") "RTN","BPSRES",168,0) . F BP35401=1:1:3 S @("BPCLCD"_BP35401)=$TR($E($P($G(^BPSC(BP02,400,BPMED,354.01,BP35401,1)),U),3,99)," ") "RTN","BPSRES",169,0) . S BPCLCD1=+BPCLCD1 I BPCLCD1=0 S BPCLCD1=1 "RTN","BPSRES",170,0) S BPPTRES=$TR($E($P($G(^BPSC(BP02,380)),U,4),3,99)," ") I BPPTRES="" S BPPTRES=1 "RTN","BPSRES",171,0) I BPPHSRV="" S BPPHSRV=1 "RTN","BPSRES",172,0) ; "RTN","BPSRES",173,0) ; Relationship Code "RTN","BPSRES",174,0) ; "RTN","BPSRES",175,0) S DIC("B")=BPRELCD "RTN","BPSRES",176,0) S DIC(0)="QEAM",DIC=9002313.19,DIC("A")="Pharmacy Relationship Code: " "RTN","BPSRES",177,0) D ^DIC "RTN","BPSRES",178,0) I ($D(DUOUT))!($D(DTOUT)) S BPQ=-1 G XPROMPTS "RTN","BPSRES",179,0) S BPRELCD=$P(Y,U,2) "RTN","BPSRES",180,0) K X,DIC,Y "RTN","BPSRES",181,0) ; "RTN","BPSRES",182,0) ; Person Code "RTN","BPSRES",183,0) ; "RTN","BPSRES",184,0) K DIR("?") S DIR(0)="FO^1:3",DIR("A")="Pharmacy Person Code",DIR("?")="Enter the Specific Person Code Assigned to the Patient by the Payer" "RTN","BPSRES",185,0) S DIR("B")=BPPSNCD "RTN","BPSRES",186,0) D ^DIR "RTN","BPSRES",187,0) I $D(DTOUT)!$D(DUOUT) S BPQ=-1 G XPROMPTS "RTN","BPSRES",188,0) S BPPSNCD=Y "RTN","BPSRES",189,0) ; "RTN","BPSRES",190,0) ; Pre-Authorization "RTN","BPSRES",191,0) ; "RTN","BPSRES",192,0) K DIR("?") S DIR(0)="FO^1:11",DIR("A")="Prior Authorization Number",DIR("?")="Enter the Number Submitted by the Provider to Identify the Prior Authorization" "RTN","BPSRES",193,0) S DIR("B")=BPPREAUT "RTN","BPSRES",194,0) D ^DIR "RTN","BPSRES",195,0) I $D(DTOUT)!$D(DUOUT) S BPQ=-1 G XPROMPTS "RTN","BPSRES",196,0) S BPPREAUT=Y "RTN","BPSRES",197,0) ; "RTN","BPSRES",198,0) ; Prior-Authorization Type Code "RTN","BPSRES",199,0) ; "RTN","BPSRES",200,0) N X,DIC,Y "RTN","BPSRES",201,0) S DIC("B")=+BPPRETYP "RTN","BPSRES",202,0) S DIC(0)="QEAM",DIC=9002313.26,DIC("A")="Prior Authorization Type Code: " "RTN","BPSRES",203,0) D ^DIC "RTN","BPSRES",204,0) I ($D(DUOUT))!($D(DTOUT)) S BPQ=-1 G XPROMPTS "RTN","BPSRES",205,0) S BPPRETYP=$P(Y,U,2) "RTN","BPSRES",206,0) K X,DIC,Y "RTN","BPSRES",207,0) ; "RTN","BPSRES",208,0) ; If there is a pending reject on the Pharmacists Worklist, or there "RTN","BPSRES",209,0) ; is a resolved or unresolved reject 79 or 88 or 943, then only display "RTN","BPSRES",210,0) ; Submission Clarification Codes and do not allow enter/edit. "RTN","BPSRES",211,0) ; "RTN","BPSRES",212,0) I $$BPSKIP(BPRXIEN,BPRXR) D G P1 "RTN","BPSRES",213,0) . F BP35401=1:1:3 I @("BPCLCD"_BP35401) D "RTN","BPSRES",214,0) . . S BPSX=+@("BPCLCD"_BP35401) "RTN","BPSRES",215,0) . . W !,"Submission Clarification Code ",BP35401,": ",BPSX "RTN","BPSRES",216,0) . . S BPCLCDX=$O(^BPS(9002313.25,"B",BPSX,"")),BPCLCDN=$P(^BPS(9002313.25,BPCLCDX,0),U,2) "RTN","BPSRES",217,0) . . W ?44,BPCLCDN "RTN","BPSRES",218,0) . . Q "RTN","BPSRES",219,0) . W !," **OPECC cannot edit Sub. Clar. Code field for this reject - refer to Pharmacist" "RTN","BPSRES",220,0) . Q "RTN","BPSRES",221,0) ; "RTN","BPSRES",222,0) ; Submission Clarification Code 1 "RTN","BPSRES",223,0) ; "RTN","BPSRES",224,0) S DIC("B")=BPCLCD1 "RTN","BPSRES",225,0) S DIC(0)="QEAM",DIC=9002313.25,DIC("A")="Submission Clarification Code 1: " "RTN","BPSRES",226,0) D ^DIC "RTN","BPSRES",227,0) I ($D(DUOUT))!($D(DTOUT)) S BPQ=-1 G XPROMPTS "RTN","BPSRES",228,0) S BPCLCD1=$P(Y,U,2) "RTN","BPSRES",229,0) K X,DIC,Y "RTN","BPSRES",230,0) ; "RTN","BPSRES",231,0) ; Submission Clarification Code 2 "RTN","BPSRES",232,0) ; "RTN","BPSRES",233,0) I +BPCLCD2 S BPCLCD2=+BPCLCD2 S DIC("B")=BPCLCD2 "RTN","BPSRES",234,0) S DIC(0)="QEAM",DIC=9002313.25,DIC("A")="Submission Clarification Code 2: ",DUP=0 "RTN","BPSRES",235,0) F D Q:BPQ=-1 Q:'DUP "RTN","BPSRES",236,0) . D ^DIC "RTN","BPSRES",237,0) . I ($D(DUOUT))!($D(DTOUT)) S BPQ=-1 Q "RTN","BPSRES",238,0) . S BPCLCD2=$P(Y,U,2) "RTN","BPSRES",239,0) . S DUP=0 I BPCLCD2=BPCLCD1 S BPCLCD2="" W !," Duplicates not allowed" S DUP=1 "RTN","BPSRES",240,0) K X,DIC,Y "RTN","BPSRES",241,0) I BPQ=-1 G XPROMPTS "RTN","BPSRES",242,0) ; "RTN","BPSRES",243,0) ; Submission Clarification Code 3 "RTN","BPSRES",244,0) ; "RTN","BPSRES",245,0) I BPCLCD2'="" D I BPQ=-1 G XPROMPTS "RTN","BPSRES",246,0) . I +BPCLCD3 S BPCLCD3=+BPCLCD3 S DIC("B")=BPCLCD3 "RTN","BPSRES",247,0) . S DIC(0)="QEAM",DIC=9002313.25,DIC("A")="Submission Clarification Code 3: ",DUP=0 "RTN","BPSRES",248,0) . F D Q:'DUP I BPQ=-1 Q "RTN","BPSRES",249,0) . . D ^DIC "RTN","BPSRES",250,0) . . I ($D(DUOUT))!($D(DTOUT)) S BPQ=-1 Q "RTN","BPSRES",251,0) . . S BPCLCD3=$P(Y,U,2) "RTN","BPSRES",252,0) . . S DUP=0 I BPCLCD3=BPCLCD1!(BPCLCD3=BPCLCD2) S BPCLCD3="" W !," Duplicates not allowed" S DUP=1 "RTN","BPSRES",253,0) . K X,DIC,Y "RTN","BPSRES",254,0) ; "RTN","BPSRES",255,0) P1 ; "RTN","BPSRES",256,0) ; "RTN","BPSRES",257,0) ; If the user opts to use the Date of Service instead of the "RTN","BPSRES",258,0) ; Release Date, then set BPADDLTXT, which will be used when creating "RTN","BPSRES",259,0) ; an entry in the Activity Log. "RTN","BPSRES",260,0) ; "RTN","BPSRES",261,0) S BPADDLTXT="" "RTN","BPSRES",262,0) S BPRELEASEDT=$$RELDATE^BPSBCKJ(+BPRXIEN,+BPRXR) "RTN","BPSRES",263,0) I BPRELEASEDT]"" D I BPQ=-1 G XPROMPTS "RTN","BPSRES",264,0) . S BPDOSDT=$$EDITDT(1,BPRXIEN,BPRXR,BP02) "RTN","BPSRES",265,0) . I BPDOSDT="^" S BPQ=-1 Q "RTN","BPSRES",266,0) . I BPDOSDT'=(BPRELEASEDT\1) S BPADDLTXT="Date of Service ("_$$FMTE^XLFDT(BPDOSDT,5)_")" "RTN","BPSRES",267,0) . Q "RTN","BPSRES",268,0) ; "RTN","BPSRES",269,0) ; Patient Residence Code "RTN","BPSRES",270,0) ; "RTN","BPSRES",271,0) N X,DIC,Y "RTN","BPSRES",272,0) S DIC("B")=+BPPTRES "RTN","BPSRES",273,0) S DIC(0)="QEAM",DIC=9002313.27,DIC("A")="Patient Residence Code: " "RTN","BPSRES",274,0) D ^DIC "RTN","BPSRES",275,0) I ($D(DUOUT))!($D(DTOUT)) S BPQ=-1 G XPROMPTS "RTN","BPSRES",276,0) S BPPTRES=$P(Y,U,2) "RTN","BPSRES",277,0) K X,DIC,Y "RTN","BPSRES",278,0) ; "RTN","BPSRES",279,0) ; Pharmacy Service Type Code "RTN","BPSRES",280,0) ; "RTN","BPSRES",281,0) N X,DIC,Y "RTN","BPSRES",282,0) S DIC("B")=+BPPHSRV "RTN","BPSRES",283,0) S DIC(0)="QEAM",DIC=9002313.28,DIC("A")="Pharmacy Service Type Code: " "RTN","BPSRES",284,0) D ^DIC "RTN","BPSRES",285,0) I ($D(DUOUT))!($D(DTOUT)) S BPQ=-1 G XPROMPTS "RTN","BPSRES",286,0) S BPPHSRV=$P(Y,U,2) "RTN","BPSRES",287,0) K X,DIC,Y "RTN","BPSRES",288,0) ; "RTN","BPSRES",289,0) ; Delay Reason Code "RTN","BPSRES",290,0) ; "RTN","BPSRES",291,0) N X,DIC,Y "RTN","BPSRES",292,0) S DIC("B")=BPDLYRS "RTN","BPSRES",293,0) S DIC(0)="QEAM",DIC=9002313.29,DIC("A")="Delay Reason Code: " "RTN","BPSRES",294,0) D ^DIC "RTN","BPSRES",295,0) I ($D(DUOUT))!($D(DTOUT)) S BPQ=-1 G XPROMPTS "RTN","BPSRES",296,0) S BPDLYRS=$P(Y,U,2) "RTN","BPSRES",297,0) K X,DIC,Y "RTN","BPSRES",298,0) ; "RTN","BPSRES",299,0) ; Patient Gender Code, 305-C5 "RTN","BPSRES",300,0) ; Limit valid entries to the values in the fields SEX and SELF "RTN","BPSRES",301,0) ; IDENTIFIED GENDER (if populated), then determine the Patient "RTN","BPSRES",302,0) ; Gender Code based on the value selected. "RTN","BPSRES",303,0) ; "RTN","BPSRES",304,0) S BPGENDER="" "RTN","BPSRES",305,0) S BPDFN=$$GET1^DIQ(9002313.59,BP59,5,"I") "RTN","BPSRES",306,0) I BPDFN'="" D I BPQ=-1 G XPROMPTS "RTN","BPSRES",307,0) . N X,DIR,Y "RTN","BPSRES",308,0) . S BPSEX=$$GET1^DIQ(2,BPDFN,.02,"I") "RTN","BPSRES",309,0) . S BPSEX=BPSEX_":"_$S(BPSEX="M":"Male",BPSEX="F":"Female",1:"")_" (Birth Sex)" "RTN","BPSRES",310,0) . S BPSIG=$$GET1^DIQ(2,BPDFN,.024,"I")_":"_$$GET1^DIQ(2,BPDFN,.024,"E")_" (Self-Identified Gender)" "RTN","BPSRES",311,0) . S DIR("B")=$P(BPSIG,":",2) "RTN","BPSRES",312,0) . S DIR(0)="SA^"_BPSEX_";"_BPSIG "RTN","BPSRES",313,0) . I $P(BPSIG,":",1)="" S DIR("B")=$P(BPSEX,":",2),$P(DIR(0),"^",2)=BPSEX "RTN","BPSRES",314,0) . S DIR("A")="Patient Gender Code: " "RTN","BPSRES",315,0) . S DIR("?")="Available Gender Codes are determined by the VistA Patient file." "RTN","BPSRES",316,0) . ; "RTN","BPSRES",317,0) . D ^DIR "RTN","BPSRES",318,0) . ; "RTN","BPSRES",319,0) . I $D(DUOUT)!$D(DTOUT) S BPQ=-1 Q "RTN","BPSRES",320,0) . S BPGENDER=$S(Y="M":1,Y="F":2,Y="N":0,1:3) "RTN","BPSRES",321,0) . Q "RTN","BPSRES",322,0) ; "RTN","BPSRES",323,0) ; "RTN","BPSRES",324,0) ; If secondary claim, setup secondary data and allow user to edit. "RTN","BPSRES",325,0) ; Get data from the primary claim, if it exists. "RTN","BPSRES",326,0) ; "RTN","BPSRES",327,0) I BPCOB=2 D I BPQ=-1 G XPROMPTS "RTN","BPSRES",328,0) . N BPSPL59,BPRTTP59 "RTN","BPSRES",329,0) . S BPRET=$$PRIMDATA^BPSPRRX6(BPRXIEN,BPRXR,.BPSECOND) "RTN","BPSRES",330,0) . ; If the primary claim data is missing, get data from the most recent secondary claim "RTN","BPSRES",331,0) . I 'BPRET,$$SECDATA^BPSPRRX6(BPRXIEN,BPRXR,.BPSPL59,.BPSECOND,.BPRTTP59) "RTN","BPSRES",332,0) . ; The PRIMARY BILL element is set by $$SECDATA. If SECDATA is not "RTN","BPSRES",333,0) . ; called, this element will be missing and we will need to create it "RTN","BPSRES",334,0) . I '$D(BPSECOND("PRIMARY BILL")) D "RTN","BPSRES",335,0) .. N BPBILL "RTN","BPSRES",336,0) .. S BPBILL=$$PAYBLPRI^BPSUTIL2(BP59) "RTN","BPSRES",337,0) .. I BPBILL>0 S BPSECOND("PRIMARY BILL")=BPBILL "RTN","BPSRES",338,0) . ; Set flag telling BPSNCPDP not to recompile the data from the BPS Transaction and the secondary claim "RTN","BPSRES",339,0) . S BPSECOND("NEW COB DATA")=1 "RTN","BPSRES",340,0) . ; $$PROMPTS displays the data and allows the user edit the data. "RTN","BPSRES",341,0) . S BPQ=$$PROMPTS^BPSPRRX3(BPRXIEN,BPRXR,BPDOSDT,.BPSECOND) "RTN","BPSRES",342,0) ; "RTN","BPSRES",343,0) ; Allow user to add to the claim additional fields which are "RTN","BPSRES",344,0) ; not on the payer sheet. $$ADDLFLDS will return 0 if no "RTN","BPSRES",345,0) ; additional fields were selected or -1 if the user exited out. "RTN","BPSRES",346,0) ; "RTN","BPSRES",347,0) S BPQ=$$ADDLFLDS^BPSRES1(BP02,BP59,.BPSADDLFLDS) "RTN","BPSRES",348,0) I BPQ=-1 G XPROMPTS "RTN","BPSRES",349,0) ; "RTN","BPSRES",350,0) ; Ask to proceed "RTN","BPSRES",351,0) ; "RTN","BPSRES",352,0) W ! "RTN","BPSRES",353,0) S BPQ=$$YESNO^BPSSCRRS("Are you sure(Y/N)") "RTN","BPSRES",354,0) I BPQ'=1 S BPQ=-1 G XPROMPTS "RTN","BPSRES",355,0) S BPQ=1 "RTN","BPSRES",356,0) ; "RTN","BPSRES",357,0) ; Save the override values and the list of additional fields "RTN","BPSRES",358,0) ; in file# 9002313.511, BPS NCPDP OVERRIDES. "RTN","BPSRES",359,0) ; "RTN","BPSRES",360,0) I '$$SAVE^BPSRES1("RED",BP59,.BPSADDLFLDS,.BPOVRIEN) S BPQ=-1 "RTN","BPSRES",361,0) ; "RTN","BPSRES",362,0) XPROMPTS ; "RTN","BPSRES",363,0) S BPOVRIEN=$S(BPQ=-1:BPQ,$G(BPOVRIEN(1))]"":BPOVRIEN(1),1:-1) "RTN","BPSRES",364,0) Q BPOVRIEN "RTN","BPSRES",365,0) ; "RTN","BPSRES",366,0) ; Prompt User for Claim to Resubmit (w/EDITS) "RTN","BPSRES",367,0) ; "RTN","BPSRES",368,0) ; Input values -> BPROMPT - prompt string "RTN","BPSRES",369,0) ; BPERRMES - the message to display when the user tries "RTN","BPSRES",370,0) ; to make multi line selection (optional) "RTN","BPSRES",371,0) ; Piece "RTN","BPSRES",372,0) ; output values -> 1 - 1 = okay, <0 = errors, 0 = quit "RTN","BPSRES",373,0) ; 2 - patient ien #2 "RTN","BPSRES",374,0) ; 3 - insurance ien #36 "RTN","BPSRES",375,0) ; 4 - ptr to #9002313.59 "RTN","BPSRES",376,0) ; 5 - 1st line for index(es) in LM "VALM" array "RTN","BPSRES",377,0) ; 6 - patient's index "RTN","BPSRES",378,0) ; 7 - claim's index "RTN","BPSRES",379,0) ASKLINE(BPROMPT,BPERRMES) ; "RTN","BPSRES",380,0) N BPRET,BPCNT "RTN","BPSRES",381,0) S BPRET="",BPCNT=0 "RTN","BPSRES",382,0) F S BPRET=$$SELLINE^BPSSCRU4(BPROMPT,"C",VALMAR,"") Q:BPRET'<0 D "RTN","BPSRES",383,0) . ; "RTN","BPSRES",384,0) . I BPCNT<1 S BPCNT=BPCNT+1 W ! "RTN","BPSRES",385,0) . E S BPCNT=0 D RE^VALM4 "RTN","BPSRES",386,0) . I BPRET=-1 W "Invalid line number" ; (invalid Patient summary line)" "RTN","BPSRES",387,0) . I BPRET=-8 W $S($G(BPERRMES)]"":BPERRMES,1:" Invalid line number") "RTN","BPSRES",388,0) . I BPRET=-4 W "Invalid line number" ; (invalid RX line)" "RTN","BPSRES",389,0) . I BPRET=-2 W "Please select Patient's summary line." "RTN","BPSRES",390,0) . I BPRET=-3 W "Please specify RX line." "RTN","BPSRES",391,0) . I ",-1,-8,-4,-2,-3,"'[(","_BPRET_",") W "Incorrect format." ; Corrupted array (",BPRET,")" "RTN","BPSRES",392,0) Q BPRET "RTN","BPSRES",393,0) ; "RTN","BPSRES",394,0) EDITDT(DFLT,BPRXIEN,BPRXR,BP02) ;Prompt User to choose correct Date of Service "RTN","BPSRES",395,0) ; "RTN","BPSRES",396,0) ; Input value -> DFLT - The data to use as the default value. If no default "RTN","BPSRES",397,0) ; is provided, Current Date of Service will be used. "RTN","BPSRES",398,0) ; "RTN","BPSRES",399,0) ; 1 - Current Date of Service "RTN","BPSRES",400,0) ; 2 - Fill Date "RTN","BPSRES",401,0) ; 3 - Release Date "RTN","BPSRES",402,0) ; "RTN","BPSRES",403,0) ; BPRXIEN - Pointer to the PRESCRIPTION file (#52) "RTN","BPSRES",404,0) ; BPRXR - Refill number for prescription "RTN","BPSRES",405,0) ; BP02 - Pointer to the BPS CLAIMS file (#9002313.02) "RTN","BPSRES",406,0) ; "RTN","BPSRES",407,0) ; Output value -> Selected Date of Service in FileMan format "RTN","BPSRES",408,0) ; "RTN","BPSRES",409,0) N BPRLS,BPFIL,BPCUR,DIR,DIRUT,DIROUT,DTOUT,DUOUT,OPT,TMP,X,Y "RTN","BPSRES",410,0) S BPRLS=$$RXRLDT^PSOBPSUT(BPRXIEN,BPRXR)\1 ;release date "RTN","BPSRES",411,0) S BPFIL=$$RXFLDT^PSOBPSUT(BPRXIEN,BPRXR)\1 ;fill date "RTN","BPSRES",412,0) S BPCUR=$$HL7TFM^XLFDT($$GET1^DIQ(9002313.02,BP02,401)) ;current date of service "RTN","BPSRES",413,0) S DFLT=$G(DFLT),DIR("B")=1,DIR("A")="Date of Service" "RTN","BPSRES",414,0) I DFLT=2,BPFIL]"" S DIR("B")=2 "RTN","BPSRES",415,0) I DFLT=3,BPRLS]"" S DIR("B")=3 "RTN","BPSRES",416,0) S OPT=1,DIR(0)="S^"_OPT_":"_$$FMTE^XLFDT(BPCUR,"5D")_" Current Date of Service",TMP(OPT)=BPCUR "RTN","BPSRES",417,0) I BPFIL'>DT,BPFILDT S OPT=OPT+1,DIR(0)=DIR(0)_";"_OPT_":"_$$FMTE^XLFDT(BPRLS,"5D")_" Release Date",TMP(OPT)=BPRLS "RTN","BPSRES",419,0) D ^DIR "RTN","BPSRES",420,0) I $D(DIRUT) S Y="^" Q Y "RTN","BPSRES",421,0) Q TMP(Y) "RTN","BPSRES",422,0) ; "RTN","BPSRES",423,0) BPSKIP(BPSRX,BPSFILL) ; Determine whether to skip the enter/edit of Submission Clarification Codes "RTN","BPSRES",424,0) ; This function will return a '1' if the enter/edit of Submission "RTN","BPSRES",425,0) ; Clarification Codes should be skipped (not allowed). "RTN","BPSRES",426,0) ; "RTN","BPSRES",427,0) N BPS7988DATE,BPSACTIVITY,BPSECMEDATE,BPSREJECT,BPSX "RTN","BPSRES",428,0) ; "RTN","BPSRES",429,0) ; If any open/unresolved rejects are on the pharmacist worklist, Quit with 1. "RTN","BPSRES",430,0) ; "RTN","BPSRES",431,0) I $$FIND^PSOREJUT(BPSRX,BPSFILL) Q 1 "RTN","BPSRES",432,0) ; "RTN","BPSRES",433,0) ; If there are any closed/resolved 79/88/943 rejects for this Rx/Fill, "RTN","BPSRES",434,0) ; pull the latest detected date/time. "RTN","BPSRES",435,0) ; If there has not been any ECME activity since that date/time, then "RTN","BPSRES",436,0) ; disallow the edit of Submission Clarification Codes, Quit with 1. "RTN","BPSRES",437,0) ; "RTN","BPSRES",438,0) S BPS7988DATE=0 "RTN","BPSRES",439,0) ; "RTN","BPSRES",440,0) ; Loop through the REJECTS multiple. "RTN","BPSRES",441,0) ; "RTN","BPSRES",442,0) S BPSREJECT=0 "RTN","BPSRES",443,0) F S BPSREJECT=$O(^PSRX(BPSRX,"REJ",BPSREJECT)) Q:'BPSREJECT D "RTN","BPSRES",444,0) . ; If a reject is not for the current fill, skip this one. "RTN","BPSRES",445,0) . I $$GET1^DIQ(52.25,BPSREJECT_","_BPSRX,5)'=BPSFILL Q "RTN","BPSRES",446,0) . ; "RTN","BPSRES",447,0) . ; If not a 79 or 88 or 943, skip this one. "RTN","BPSRES",448,0) . I ",79,88,943,"'[(","_$$GET1^DIQ(52.25,BPSREJECT_","_BPSRX,.01)_",") Q "RTN","BPSRES",449,0) . ; "RTN","BPSRES",450,0) . ; Pull DATE/TIME DETECTED. If the date/time is later than "RTN","BPSRES",451,0) . ; BPS7988DATE, then reset BPS7988DATE to that date/time. "RTN","BPSRES",452,0) . S BPSX=$$GET1^DIQ(52.25,BPSREJECT_","_BPSRX,1,"I") "RTN","BPSRES",453,0) . I BPSX>BPS7988DATE S BPS7988DATE=BPSX "RTN","BPSRES",454,0) . Q "RTN","BPSRES",455,0) ; "RTN","BPSRES",456,0) ; If then Quit with 0. "RTN","BPSRES",457,0) ; "RTN","BPSRES",458,0) I BPS7988DATE=0 Q 0 "RTN","BPSRES",459,0) ; "RTN","BPSRES",460,0) ; Once we have the most recent DATE/TIME DETECTED, determine whether "RTN","BPSRES",461,0) ; there is ECME activity later than that. "RTN","BPSRES",462,0) ; "RTN","BPSRES",463,0) ; Loop through entries the ACTIVITY LOG multiple. "RTN","BPSRES",464,0) ; "RTN","BPSRES",465,0) S (BPSX,BPSACTIVITY,BPSECMEDATE)=0 "RTN","BPSRES",466,0) F S BPSACTIVITY=$O(^PSRX(BPSRX,"A",BPSACTIVITY)) Q:'BPSACTIVITY D "RTN","BPSRES",467,0) . ; If the REASON is not "M" (=ECME), skip. "RTN","BPSRES",468,0) . I $$GET1^DIQ(52.3,BPSACTIVITY_","_BPSRX,.02,"I")'="M" Q "RTN","BPSRES",469,0) . ; "RTN","BPSRES",470,0) . ; Pull the date/time stamp from the activity log entry. If later "RTN","BPSRES",471,0) . ; than what we found so far, update BPSECMEDATE. "RTN","BPSRES",472,0) . S BPSX=$$GET1^DIQ(52.3,BPSACTIVITY_","_BPSRX,.01,"I") "RTN","BPSRES",473,0) . I BPSX>BPSECMEDATE S BPSECMEDATE=BPSX "RTN","BPSRES",474,0) . Q "RTN","BPSRES",475,0) ; "RTN","BPSRES",476,0) ; If the BPSECMEDATE is later than BPS7988DATE, then Quit with 0 "RTN","BPSRES",477,0) ; to allow the edit of Submission Clarification Codes. Otherwise, "RTN","BPSRES",478,0) ; Quit with 1 to skip, not allow, the enter/edit of those codes. "RTN","BPSRES",479,0) ; When a claim is rejected, the time stamp on the Activity Log may "RTN","BPSRES",480,0) ; be a second or two later than the time stamp on the Reject. "RTN","BPSRES",481,0) ; Therefore, we add 60 seconds to the time stamp on the reject when "RTN","BPSRES",482,0) ; making this comparison. "RTN","BPSRES",483,0) ; "RTN","BPSRES",484,0) I BPSECMEDATE>(BPS7988DATE+.00006) Q 0 "RTN","BPSRES",485,0) Q 1 "RTN","BPSRES",486,0) ; "RTN","BPSRES1") 0^3^B58424705 "RTN","BPSRES1",1,0) BPSRES1 ;AITC/MRD - ECME SCREEN RESUBMIT W/EDITS ;10/23/17 "RTN","BPSRES1",2,0) ;;1.0;E CLAIMS MGMT ENGINE;**23,24,32**;JUN 2004;Build 15 "RTN","BPSRES1",3,0) ;;Per VA Directive 6402, this routine should not be modified. "RTN","BPSRES1",4,0) ; "RTN","BPSRES1",5,0) ADDLFLDS(BPS02,BPS59,BPSADDLFLDS,BPSDOS) ; Add fields to a claim. "RTN","BPSRES1",6,0) ; This function allows the user to add to claim fields not on payer "RTN","BPSRES1",7,0) ; sheet. It is used by the RED/Resubmit with Edits Action on the "RTN","BPSRES1",8,0) ; ECME User Screen and by the PRO Option (Process Secondary/TRICARE "RTN","BPSRES1",9,0) ; Rx to ECME). "RTN","BPSRES1",10,0) ; Input: BPS02 = Pointer to BPS CLAIMS "RTN","BPSRES1",11,0) ; BPS59 = Pointer to BSP TRANSACTION "RTN","BPSRES1",12,0) ; BPSDOS = Date of Service; if passed in, then display "RTN","BPSRES1",13,0) ; when listing fields to be added to claim "RTN","BPSRES1",14,0) ; This function will return: "RTN","BPSRES1",15,0) ; 1 - If user entered additional fields. "RTN","BPSRES1",16,0) ; 0 - If user added no fields. "RTN","BPSRES1",17,0) ; -1 - If user exited out via "^". "RTN","BPSRES1",18,0) ; This function will also set up the array BPSADDFLDS if the user "RTN","BPSRES1",19,0) ; chooses to add any fields to the claim. "RTN","BPSRES1",20,0) ; BPSADDLFLDS(Field IEN) = Value to Send "RTN","BPSRES1",21,0) ; "RTN","BPSRES1",22,0) N BPS,BPSFIELD,BPSGETCODE,BPSPAYER,BPSQ,BPSSEGMENT "RTN","BPSRES1",23,0) N DIC,MEDN,TRANLIST,X,Y "RTN","BPSRES1",24,0) ; "RTN","BPSRES1",25,0) ; Prompt user whether to enter additional fields. If user enters "RTN","BPSRES1",26,0) ; "No", display the Date of Service, if it exists, then Quit with 0. "RTN","BPSRES1",27,0) ; If user enters "^", Quit with -1. "RTN","BPSRES1",28,0) ; "RTN","BPSRES1",29,0) W ! "RTN","BPSRES1",30,0) S BPSQ=$$YESNO^BPSSCRRS("Submit NCPDP Field Not on Payer Sheet (Y/N)","N") "RTN","BPSRES1",31,0) I BPSQ=0,$G(BPSDOS)'="" W !!,"Fields entered to transmit:",!,?4,"Date of Service: ",$$FMTE^XLFDT(BPSDOS,"5D") "RTN","BPSRES1",32,0) I BPSQ'=1 Q BPSQ "RTN","BPSRES1",33,0) ; "RTN","BPSRES1",34,0) ; Kill array that will contain list of fields to be added. "RTN","BPSRES1",35,0) ; "RTN","BPSRES1",36,0) K BPSADDLFLDS "RTN","BPSRES1",37,0) ; "RTN","BPSRES1",38,0) ; Build an array listing the fields already on the payer sheet and an "RTN","BPSRES1",39,0) ; array listing all segments on the payer sheet. Include all segments, "RTN","BPSRES1",40,0) ; though some may be excluded later. "RTN","BPSRES1",41,0) ; "RTN","BPSRES1",42,0) D ARRAYS(BPS02,.BPSPAYER,.BPSSEGMENT) "RTN","BPSRES1",43,0) I 'BPSPAYER Q 0 "RTN","BPSRES1",44,0) ; "RTN","BPSRES1",45,0) ; Build BPS array. While each field in the file BPS NCPDP FIELD DEFS "RTN","BPSRES1",46,0) ; has Get Code (executable M code) for pulling the data value, the way "RTN","BPSRES1",47,0) ; this has been implemented is that first the subroutine $$BPS^BPSOSCB "RTN","BPSRES1",48,0) ; pulls many fields of data, building the BPS array, and then the "RTN","BPSRES1",49,0) ; Get Code for each field puts into BPS("X") a value from the BPS "RTN","BPSRES1",50,0) ; array. Because the system needs to display to the user the value "RTN","BPSRES1",51,0) ; that would be sent with a field being added to the claim, we need to "RTN","BPSRES1",52,0) ; build the entire BPS array, which will be used by the Get Code for "RTN","BPSRES1",53,0) ; any fields selected by the user. TRANLIST is an array listing all "RTN","BPSRES1",54,0) ; BPS Transactions in this batch of claims. However, the VA does not "RTN","BPSRES1",55,0) ; ever batch claims, so there is always only one transaction in that "RTN","BPSRES1",56,0) ; list. BPS(9002313.0201) must be set to 1. It should never return a "RTN","BPSRES1",57,0) ; value other than 0, but if it does, Quit. "RTN","BPSRES1",58,0) ; "RTN","BPSRES1",59,0) S TRANLIST(BPS59)="" "RTN","BPSRES1",60,0) S BPS(9002313.0201)=1 "RTN","BPSRES1",61,0) S X=$$BPS^BPSOSCB "RTN","BPSRES1",62,0) I X W !,$P(X,U,2),".",!,"Fields may not be added at this time." Q 0 "RTN","BPSRES1",63,0) ; "RTN","BPSRES1",64,0) ; Display help text. "RTN","BPSRES1",65,0) ; "RTN","BPSRES1",66,0) W !!,"Enter a valid NCPDP Field name or number. Enter '??' for" "RTN","BPSRES1",67,0) W !,"a list of possible choices. Fields already on the payer sheet" "RTN","BPSRES1",68,0) W !,"are excluded from the list of possible choices. Also excluded" "RTN","BPSRES1",69,0) W !,"are any fields that do not have logic to pull data from VistA" "RTN","BPSRES1",70,0) W !,"(i.e. fields that will always be )." "RTN","BPSRES1",71,0) ; "RTN","BPSRES1",72,0) A1 ; Prompt user for an NCPDP field to add to the claim. "RTN","BPSRES1",73,0) ; "RTN","BPSRES1",74,0) K DIC "RTN","BPSRES1",75,0) ; "RTN","BPSRES1",76,0) S DIC=9002313.91 "RTN","BPSRES1",77,0) S DIC(0)="AEMQ" "RTN","BPSRES1",78,0) S DIC("A")="NCPDP Field Name or Number: " "RTN","BPSRES1",79,0) S DIC("S")="I $$CHECK^BPSRES1(Y,.BPSPAYER,.BPSSEGMENT)" "RTN","BPSRES1",80,0) S DIC("T")="" "RTN","BPSRES1",81,0) ; "RTN","BPSRES1",82,0) W ! "RTN","BPSRES1",83,0) D ^DIC "RTN","BPSRES1",84,0) ; "RTN","BPSRES1",85,0) ; When the user just hits , skip down to A2. "RTN","BPSRES1",86,0) ; "RTN","BPSRES1",87,0) I X="" G A2 "RTN","BPSRES1",88,0) ; "RTN","BPSRES1",89,0) I Y=-1 Q -1 "RTN","BPSRES1",90,0) S BPSFIELD=+Y "RTN","BPSRES1",91,0) ; "RTN","BPSRES1",92,0) ; Disallow a field already added. "RTN","BPSRES1",93,0) ; "RTN","BPSRES1",94,0) I $D(BPSADDLFLDS(BPSFIELD)) W !,?4,"This field has already been added to the claim.",*7 G A1 "RTN","BPSRES1",95,0) ; "RTN","BPSRES1",96,0) ; Display to the user the value to be sent with this field. "RTN","BPSRES1",97,0) ; "RTN","BPSRES1",98,0) S BPS("X")="" "RTN","BPSRES1",99,0) S MEDN=1 ; Required for some GET codes. "RTN","BPSRES1",100,0) S BPSGETCODE=0 "RTN","BPSRES1",101,0) F S BPSGETCODE=$O(^BPSF(9002313.91,BPSFIELD,10,BPSGETCODE)) Q:'BPSGETCODE X $G(^BPSF(9002313.91,BPSFIELD,10,BPSGETCODE,0)) "RTN","BPSRES1",102,0) W !,?4,"Value to transmit: ",BPS("X") "RTN","BPSRES1",103,0) S BPSQ=$$YESNO^BPSSCRRS("Transmit with claim (Y/N)","Y") "RTN","BPSRES1",104,0) I BPSQ=0 G A1 "RTN","BPSRES1",105,0) I BPSQ=-1 K BPSADDLFLDS Q -1 "RTN","BPSRES1",106,0) ; "RTN","BPSRES1",107,0) ; Add selected field to array (Y=internal field #). "RTN","BPSRES1",108,0) ; "RTN","BPSRES1",109,0) S BPSADDLFLDS(BPSFIELD)=BPS("X") "RTN","BPSRES1",110,0) ; "RTN","BPSRES1",111,0) G A1 "RTN","BPSRES1",112,0) ; "RTN","BPSRES1",113,0) A2 ; User is done selecting fields to add. "RTN","BPSRES1",114,0) ; "RTN","BPSRES1",115,0) ; If user added no fields, Quit with 0. "RTN","BPSRES1",116,0) ; "RTN","BPSRES1",117,0) I '$D(BPSADDLFLDS),'$G(BPSDOS) Q 0 "RTN","BPSRES1",118,0) ; "RTN","BPSRES1",119,0) ; Display to the user the list of fields being added to the claim. "RTN","BPSRES1",120,0) ; "RTN","BPSRES1",121,0) W !!,"Fields entered to transmit:" "RTN","BPSRES1",122,0) I $G(BPSDOS)'="" W !,?4,"Date of Service: ",$$FMTE^XLFDT(BPSDOS,"5D") "RTN","BPSRES1",123,0) S BPSFIELD="" "RTN","BPSRES1",124,0) F S BPSFIELD=$O(BPSADDLFLDS(BPSFIELD)) Q:'BPSFIELD D "RTN","BPSRES1",125,0) . W !,?4,$$GET1^DIQ(9002313.91,BPSFIELD,.01),"-" "RTN","BPSRES1",126,0) . W $$GET1^DIQ(9002313.91,BPSFIELD,.06)," " "RTN","BPSRES1",127,0) . W $$GET1^DIQ(9002313.91,BPSFIELD,.03),": " "RTN","BPSRES1",128,0) . W BPSADDLFLDS(BPSFIELD) "RTN","BPSRES1",129,0) . Q "RTN","BPSRES1",130,0) ; "RTN","BPSRES1",131,0) Q 1 "RTN","BPSRES1",132,0) ; "RTN","BPSRES1",133,0) ARRAYS(BPS02,BPSPAYER,BPSSEGMENT) ; Build BPSPAYER array and BPSSEGMENT array. "RTN","BPSRES1",134,0) ; "RTN","BPSRES1",135,0) ; Build an array listing the fields already on the payer sheet and "RTN","BPSRES1",136,0) ; an array listing all segments on the payer sheet. Include all "RTN","BPSRES1",137,0) ; segments, though some may be excluded later. "RTN","BPSRES1",138,0) ; "RTN","BPSRES1",139,0) N BPSFIELD,BPSORDER "RTN","BPSRES1",140,0) ; "RTN","BPSRES1",141,0) S BPSPAYER=$$GET1^DIQ(9002313.02,BPS02,.02,"I") ; Payer Sheet. "RTN","BPSRES1",142,0) I 'BPSPAYER Q "RTN","BPSRES1",143,0) F BPSSEGMENT=100:10:300 D "RTN","BPSRES1",144,0) . I '$D(^BPSF(9002313.92,BPSPAYER,BPSSEGMENT)) Q "RTN","BPSRES1",145,0) . S BPSSEGMENT(BPSSEGMENT)="" "RTN","BPSRES1",146,0) . S BPSORDER=0 "RTN","BPSRES1",147,0) . F S BPSORDER=$O(^BPSF(9002313.92,BPSPAYER,BPSSEGMENT,BPSORDER)) Q:'BPSORDER D "RTN","BPSRES1",148,0) . . S BPSFIELD=$P($G(^BPSF(9002313.92,BPSPAYER,BPSSEGMENT,BPSORDER,0)),"^",2) ; Field IEN "RTN","BPSRES1",149,0) . . I BPSFIELD'="" S BPSPAYER(BPSFIELD)="" "RTN","BPSRES1",150,0) . . Q "RTN","BPSRES1",151,0) . Q "RTN","BPSRES1",152,0) ; "RTN","BPSRES1",153,0) Q "RTN","BPSRES1",154,0) ; "RTN","BPSRES1",155,0) CHECK(BPSY,BPSPAYER,BPSSEGMENT) ; Screen for BPS NCPDP FIELD DEFS lookup. See ADDLFLDS above. "RTN","BPSRES1",156,0) ; This function is called for a given entry in the file BPS "RTN","BPSRES1",157,0) ; NCPDP FIELD DEFS, where +Y will be the IEN. If this function "RTN","BPSRES1",158,0) ; returns a 1, then this entry is a valid choice. If this "RTN","BPSRES1",159,0) ; function returns a 0, then this entry will not be displayed to "RTN","BPSRES1",160,0) ; the user when listing possible choices and this entry will not "RTN","BPSRES1",161,0) ; be a valid choice for the user. "RTN","BPSRES1",162,0) ; "RTN","BPSRES1",163,0) ; Disallow if already on the payer sheet. "RTN","BPSRES1",164,0) ; "RTN","BPSRES1",165,0) I $D(BPSPAYER(+BPSY)) Q 0 "RTN","BPSRES1",166,0) ; "RTN","BPSRES1",167,0) ; Disallow if this field is not on a request segment or if this "RTN","BPSRES1",168,0) ; field is on a segment not on the payer sheet. "RTN","BPSRES1",169,0) ; "RTN","BPSRES1",170,0) S BPSSEGMENT=$P($G(^BPSF(9002313.91,+BPSY,5)),"^",4) ; Request Segment. "RTN","BPSRES1",171,0) S BPSSEGMENT=$P($G(^BPSF(9002313.9,+BPSSEGMENT,0)),"^",2) "RTN","BPSRES1",172,0) I BPSSEGMENT="" Q 0 "RTN","BPSRES1",173,0) I '$D(BPSSEGMENT(BPSSEGMENT)) Q 0 "RTN","BPSRES1",174,0) ; "RTN","BPSRES1",175,0) ; There are many segments the VA does not send, even if that "RTN","BPSRES1",176,0) ; segment is on a payer sheet. Disallow any fields that are "RTN","BPSRES1",177,0) ; on one of those segments. "RTN","BPSRES1",178,0) ; "RTN","BPSRES1",179,0) I ",140,170,200,210,220,230,240,250,260,270,280,290,300,"[(","_BPSSEGMENT_",") Q 0 "RTN","BPSRES1",180,0) ; "RTN","BPSRES1",181,0) ; Disallow if Get Code is simply Setting BPS("X") to "". "RTN","BPSRES1",182,0) ; "RTN","BPSRES1",183,0) I $G(^BPSF(9002313.91,+BPSY,10,1,0))["S BPS(""X"")=""""" Q 0 "RTN","BPSRES1",184,0) ; "RTN","BPSRES1",185,0) Q 1 "RTN","BPSRES1",186,0) ; "RTN","BPSRES1",187,0) SAVE(BPSACTION,BPS59,BPSADDLFLDS,BPSOVRIEN) ; Save into BPS NCPDP OVERRIDES (#9002313.511) "RTN","BPSRES1",188,0) ; "RTN","BPSRES1",189,0) ; If the user chooses to add any fields to the claim, each field "RTN","BPSRES1",190,0) ; will be listed as BPSADDLFLDS(Field IEN). "RTN","BPSRES1",191,0) ; "RTN","BPSRES1",192,0) ; Input: BPSACTION = Action selected by user (e.g. RED, PRO) "RTN","BPSRES1",193,0) ; BPS59 = Pointer to BPS TRANSACTIONS "RTN","BPSRES1",194,0) ; BPSADDLFLDS = Passed by reference, array listing the "RTN","BPSRES1",195,0) ; NCPDP fields to be added to the claim. "RTN","BPSRES1",196,0) ; BPSADDLFLDS(NCPDP Field) = "" "RTN","BPSRES1",197,0) ; BPSOVRIEN = Passed by reference, ien of entry in the "RTN","BPSRES1",198,0) ; file BPS NCPDP OVERRIDE "RTN","BPSRES1",199,0) ; "RTN","BPSRES1",200,0) N BPSFDA,BPSFIELD,BPSMSG,BPSCNT,BPSFIELD "RTN","BPSRES1",201,0) ; "RTN","BPSRES1",202,0) S BPSFDA(9002313.511,"+1,",.01)=BPS59 "RTN","BPSRES1",203,0) D NOW^%DTC "RTN","BPSRES1",204,0) S BPSFDA(9002313.511,"+1,",.02)=% "RTN","BPSRES1",205,0) ; "RTN","BPSRES1",206,0) ; Store the fields for which the user was prompted. "RTN","BPSRES1",207,0) ; "RTN","BPSRES1",208,0) S BPSCNT=1 "RTN","BPSRES1",209,0) I BPSACTION="RED" D "RTN","BPSRES1",210,0) . S BPSFIELD=$O(^BPSF(9002313.91,"B",303,"")) I BPSFIELD]"" S BPSFDA(9002313.5111,"+2,+1,",.01)=BPSFIELD,BPSFDA(9002313.5111,"+2,+1,",.02)=BPPSNCD "RTN","BPSRES1",211,0) . S BPSFIELD=$O(^BPSF(9002313.91,"B",306,"")) I BPSFIELD]"" S BPSFDA(9002313.5111,"+3,+1,",.01)=BPSFIELD,BPSFDA(9002313.5111,"+3,+1,",.02)=BPRELCD "RTN","BPSRES1",212,0) . S BPSFIELD=$O(^BPSF(9002313.91,"B",462,"")) I BPSFIELD]"" S BPSFDA(9002313.5111,"+4,+1,",.01)=BPSFIELD,BPSFDA(9002313.5111,"+4,+1,",.02)=BPPREAUT "RTN","BPSRES1",213,0) . S BPSFIELD=$O(^BPSF(9002313.91,"B",461,"")) I BPSFIELD]"" S BPSFDA(9002313.5111,"+5,+1,",.01)=BPSFIELD,BPSFDA(9002313.5111,"+5,+1,",.02)=BPPRETYP "RTN","BPSRES1",214,0) . S BPSFIELD=$O(^BPSF(9002313.91,"B",420,"")) I BPSFIELD]"" S BPSFDA(9002313.5111,"+6,+1,",.01)=BPSFIELD,BPSFDA(9002313.5111,"+6,+1,",.02)=BPCLCD1_"~"_$G(BPCLCD2)_"~"_$G(BPCLCD3) "RTN","BPSRES1",215,0) . S BPSFIELD=$O(^BPSF(9002313.91,"B",384,"")) I BPSFIELD]"" S BPSFDA(9002313.5111,"+7,+1,",.01)=BPSFIELD,BPSFDA(9002313.5111,"+7,+1,",.02)=BPPTRES "RTN","BPSRES1",216,0) . S BPSFIELD=$O(^BPSF(9002313.91,"B",147,"")) I BPSFIELD]"" S BPSFDA(9002313.5111,"+8,+1,",.01)=BPSFIELD,BPSFDA(9002313.5111,"+8,+1,",.02)=BPPHSRV "RTN","BPSRES1",217,0) . S BPSFIELD=$O(^BPSF(9002313.91,"B",357,"")) I BPSFIELD]"" S BPSFDA(9002313.5111,"+9,+1,",.01)=BPSFIELD,BPSFDA(9002313.5111,"+9,+1,",.02)=BPDLYRS "RTN","BPSRES1",218,0) . S BPSFIELD=$O(^BPSF(9002313.91,"B",305,"")) I BPSFIELD]"" S BPSFDA(9002313.5111,"+10,+1,",.01)=BPSFIELD,BPSFDA(9002313.5111,"+10,+1,",.02)=BPGENDER "RTN","BPSRES1",219,0) . S BPSCNT=10 "RTN","BPSRES1",220,0) . Q "RTN","BPSRES1",221,0) ; "RTN","BPSRES1",222,0) ; Store additional NCPDP fields which the user chose to add to the "RTN","BPSRES1",223,0) ; the resubmitted claim. "RTN","BPSRES1",224,0) ; "RTN","BPSRES1",225,0) S BPSFIELD=0 "RTN","BPSRES1",226,0) F S BPSFIELD=$O(BPSADDLFLDS(BPSFIELD)) Q:'BPSFIELD D "RTN","BPSRES1",227,0) . S BPSCNT=BPSCNT+1 "RTN","BPSRES1",228,0) . S BPSFDA(9002313.5112,"+"_BPSCNT_",+1,",.01)=BPSFIELD ; Field# "RTN","BPSRES1",229,0) . S BPSFDA(9002313.5112,"+"_BPSCNT_",+1,",.02)=$$GET1^DIQ(9002313.91,BPSFIELD,2,"I") ; Segment# "RTN","BPSRES1",230,0) . Q "RTN","BPSRES1",231,0) ; "RTN","BPSRES1",232,0) D UPDATE^DIE("","BPSFDA","BPSOVRIEN","BPSMSG") "RTN","BPSRES1",233,0) ; "RTN","BPSRES1",234,0) I $D(BPSMSG("DIERR")) D Q -1 "RTN","BPSRES1",235,0) . W !!,"Could not save override information into BPS NCPDP OVERRIDE file.",! "RTN","BPSRES1",236,0) . N DIR "RTN","BPSRES1",237,0) . S DIR(0)="E" "RTN","BPSRES1",238,0) . S DIR("A")="Press Return to continue." "RTN","BPSRES1",239,0) . D ^DIR "RTN","BPSRES1",240,0) . Q "RTN","BPSRES1",241,0) ; "RTN","BPSRES1",242,0) Q 1 "RTN","BPSRES1",243,0) ; "SEC","^DIC",9002313.02,9002313.02,0,"AUDIT") @ "SEC","^DIC",9002313.02,9002313.02,0,"DD") @ "SEC","^DIC",9002313.02,9002313.02,0,"DEL") @ "SEC","^DIC",9002313.02,9002313.02,0,"LAYGO") @ "SEC","^DIC",9002313.02,9002313.02,0,"RD") Pp "SEC","^DIC",9002313.02,9002313.02,0,"WR") @ "SEC","^DIC",9002313.91,9002313.91,0,"AUDIT") @ "SEC","^DIC",9002313.91,9002313.91,0,"DD") @ "SEC","^DIC",9002313.91,9002313.91,0,"DEL") @ "SEC","^DIC",9002313.91,9002313.91,0,"LAYGO") @ "SEC","^DIC",9002313.91,9002313.91,0,"RD") Pp "SEC","^DIC",9002313.91,9002313.91,0,"WR") @ "VER") 8.0^22.2 "^DD",9002313.02,9002313.02,0) FIELD^^618^77 "^DD",9002313.02,9002313.02,0,"DDA") N "^DD",9002313.02,9002313.02,0,"DT") 3220331 "^DD",9002313.02,9002313.02,0,"IX","AD",9002313.02,.04) "^DD",9002313.02,9002313.02,0,"IX","AE",9002313.02,.05) "^DD",9002313.02,9002313.02,0,"IX","AF",9002313.02,401) "^DD",9002313.02,9002313.02,0,"IX","AG",9002313.02,902) "^DD",9002313.02,9002313.02,0,"IX","B",9002313.02,.01) "^DD",9002313.02,9002313.02,0,"IX","C",9002313.02,1.01) "^DD",9002313.02,9002313.02,0,"NM","BPS CLAIMS") "^DD",9002313.02,9002313.02,0,"PT",9002313.03,.01) "^DD",9002313.02,9002313.02,0,"PT",9002313.31,.03) "^DD",9002313.02,9002313.02,0,"PT",9002313.57,3) "^DD",9002313.02,9002313.02,0,"PT",9002313.57,401) "^DD",9002313.02,9002313.02,0,"PT",9002313.59,3) "^DD",9002313.02,9002313.02,0,"PT",9002313.59,401) "^DD",9002313.02,9002313.02,0,"VRPK") BPS "^DD",9002313.02,9002313.02,.01,0) CLAIM ID^F^^0;1^K:$L(X)>32!($L(X)<1) X "^DD",9002313.02,9002313.02,.01,1,0) ^.1 "^DD",9002313.02,9002313.02,.01,1,1,0) 9002313.02^B^MUMPS "^DD",9002313.02,9002313.02,.01,1,1,1) S ^BPSC("B",$E(X,1,32),DA)="" "^DD",9002313.02,9002313.02,.01,1,1,2) K ^BPSC("B",$E(X,1,32),DA) "^DD",9002313.02,9002313.02,.01,1,1,"DT") 3030725 "^DD",9002313.02,9002313.02,.01,3) Answer must be 1-32 characters in length. "^DD",9002313.02,9002313.02,.01,21,0) ^^4^4^3080604^ "^DD",9002313.02,9002313.02,.01,21,1,0) External Claim ID value. This value is a concatenation of the text 'VA' "^DD",9002313.02,9002313.02,.01,21,2,0) along with the current year, the pharmacy ID, the VA National Plan ID "^DD",9002313.02,9002313.02,.01,21,3,0) (without the alpha prefix), and a unique sequence number. Each of the "^DD",9002313.02,9002313.02,.01,21,4,0) four pieces is delimited by the equal sign ("="). "^DD",9002313.02,9002313.02,.01,"DT") 3080604 "^DD",9002313.02,9002313.02,.02,0) ELECTRONIC PAYER^P9002313.92'^BPSF(9002313.92,^0;2^Q "^DD",9002313.02,9002313.02,.02,3) Enter the payer sheet for the claim "^DD",9002313.02,9002313.02,.02,21,0) ^.001^1^1^3101001^^ "^DD",9002313.02,9002313.02,.02,21,1,0) This is the payer sheet used by the claim "^DD",9002313.02,9002313.02,.02,"DT") 3080102 "^DD",9002313.02,9002313.02,.04,0) TRANSMIT FLAG^S^1:YES (BATCH FILE);0:NO;2:YES (POINT OF SALE);^0;4^Q "^DD",9002313.02,9002313.02,.04,1,0) ^.1 "^DD",9002313.02,9002313.02,.04,1,1,0) 9002313.02^AD "^DD",9002313.02,9002313.02,.04,1,1,1) S ^BPSC("AD",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.02,.04,1,1,2) K ^BPSC("AD",$E(X,1,30),DA) "^DD",9002313.02,9002313.02,.04,1,1,"DT") 2950524 "^DD",9002313.02,9002313.02,.04,3) Specify if this claim should be transmitted and the mode. "^DD",9002313.02,9002313.02,.04,21,0) ^.001^2^2^3050316^^ "^DD",9002313.02,9002313.02,.04,21,1,0) Numerical code to indicate a transmit status. Current values are 0 for "^DD",9002313.02,9002313.02,.04,21,2,0) 'No' 1 for 'Yes' Batch and 2 for 'Yes' Point of Sale. "^DD",9002313.02,9002313.02,.04,"DT") 3080102 "^DD",9002313.02,9002313.02,.05,0) TRANSMITTED ON^DO^^0;5^S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X "^DD",9002313.02,9002313.02,.05,.1) "^DD",9002313.02,9002313.02,.05,1,0) ^.1 "^DD",9002313.02,9002313.02,.05,1,1,0) 9002313.02^AE "^DD",9002313.02,9002313.02,.05,1,1,1) S ^BPSC("AE",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.02,.05,1,1,2) K ^BPSC("AE",$E(X,1,30),DA) "^DD",9002313.02,9002313.02,.05,1,1,"DT") 2950622 "^DD",9002313.02,9002313.02,.05,2) S Y(0)=Y S Y=$$FM2EXT^BPSOSU1(Y) "^DD",9002313.02,9002313.02,.05,2.1) S Y=$$FM2EXT^BPSOSU1(Y) "^DD",9002313.02,9002313.02,.05,3) Enter Date/Time this claim was transmitted "^DD",9002313.02,9002313.02,.05,21,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,.05,21,1,0) Date on which the data was transmitted. "^DD",9002313.02,9002313.02,.05,"DT") 3080102 "^DD",9002313.02,9002313.02,.06,0) CREATED ON^DO^^0;6^S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X "^DD",9002313.02,9002313.02,.06,2) S Y(0)=Y S Y=$$FM2EXT^BPSOSU1(Y) "^DD",9002313.02,9002313.02,.06,2.1) S Y=$$FM2EXT^BPSOSU1(Y) "^DD",9002313.02,9002313.02,.06,3) Enter Date/Time this claim was created "^DD",9002313.02,9002313.02,.06,21,0) ^^1^1^3031125^^ "^DD",9002313.02,9002313.02,.06,21,1,0) Date on which this record was created. "^DD",9002313.02,9002313.02,.06,"DT") 3080102 "^DD",9002313.02,9002313.02,.07,0) AUTO REVERSE FLAG^S^0:NO;1:UNRELEASED CLAIM;2:INPATIENT CLAIM;^0;7^Q "^DD",9002313.02,9002313.02,.07,3) If auto-reversed, enter the type of auto-reversal "^DD",9002313.02,9002313.02,.07,21,0) ^^3^3^3060105^ "^DD",9002313.02,9002313.02,.07,21,1,0) This flag is marking ECME Claims that were automatically reversed because "^DD",9002313.02,9002313.02,.07,21,2,0) the Prescription was not released in time or the claim was an inpatient "^DD",9002313.02,9002313.02,.07,21,3,0) claim. "^DD",9002313.02,9002313.02,.07,"DT") 3060105 "^DD",9002313.02,9002313.02,.08,0) TRANSACTION^P9002313.59'^BPST(^0;8^Q "^DD",9002313.02,9002313.02,.08,3) Enter the transaction for the claim. "^DD",9002313.02,9002313.02,.08,21,0) ^.001^1^1^3220127^^^^ "^DD",9002313.02,9002313.02,.08,21,1,0) This is the ECME transaction that generates the claim. "^DD",9002313.02,9002313.02,.08,"DT") 3210414 "^DD",9002313.02,9002313.02,1.01,0) PATIENT NAME^F^^1;1^K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>30!($L(X)<1) X "^DD",9002313.02,9002313.02,1.01,1,0) ^.1 "^DD",9002313.02,9002313.02,1.01,1,1,0) 9002313.02^C "^DD",9002313.02,9002313.02,1.01,1,1,1) S ^BPSC("C",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.02,1.01,1,1,2) K ^BPSC("C",$E(X,1,30),DA) "^DD",9002313.02,9002313.02,1.01,1,1,"DT") 2950606 "^DD",9002313.02,9002313.02,1.01,3) Answer must be 1-30 characters in length. "^DD",9002313.02,9002313.02,1.01,21,0) ^^2^2^3040331^ "^DD",9002313.02,9002313.02,1.01,21,1,0) Patient name extracted from the VA patient file. This entry is free text "^DD",9002313.02,9002313.02,1.01,21,2,0) to accommodate the NCPDP formatting requirements. "^DD",9002313.02,9002313.02,1.01,"DT") 3080102 "^DD",9002313.02,9002313.02,1.04,0) GROUP INSURANCE PLAN^P355.3'^IBA(355.3,^1;4^Q "^DD",9002313.02,9002313.02,1.04,3) Enter the Group Insurance "^DD",9002313.02,9002313.02,1.04,21,0) ^^1^1^3061120^ "^DD",9002313.02,9002313.02,1.04,21,1,0) Internal identifier number for the Group Insurance Record "^DD",9002313.02,9002313.02,1.04,"DT") 3080102 "^DD",9002313.02,9002313.02,101,0) IIN NUMBER^F^^100;1^K:$L(X)>6!($L(X)<6) X "^DD",9002313.02,9002313.02,101,3) Answer must be 6 characters in length. "^DD",9002313.02,9002313.02,101,21,0) ^^1^1^3031124^ "^DD",9002313.02,9002313.02,101,21,1,0) Card Issuer ID or Bank ID Number used for network routing. "^DD",9002313.02,9002313.02,101,"DT") 3210422 "^DD",9002313.02,9002313.02,102,0) VERSION/RELEASE NUMBER^F^^100;2^K:$L(X)>2!($L(X)<2) X "^DD",9002313.02,9002313.02,102,3) Answer must be 2 characters in length. "^DD",9002313.02,9002313.02,102,21,0) ^^2^2^3031124^ "^DD",9002313.02,9002313.02,102,21,1,0) Code identifying the Enrollment Standard format of the file sent or "^DD",9002313.02,9002313.02,102,21,2,0) received. "^DD",9002313.02,9002313.02,102,"DT") 3210329 "^DD",9002313.02,9002313.02,103,0) TRANSACTION CODE^F^^100;3^K:$L(X)>2!($L(X)<2) X "^DD",9002313.02,9002313.02,103,3) Answer must be 2 characters in length. "^DD",9002313.02,9002313.02,103,21,0) ^^15^15^3031124^ "^DD",9002313.02,9002313.02,103,21,1,0) Code to identify the transaction type for this claim. "^DD",9002313.02,9002313.02,103,21,2,0) E1=Eligibility Verification "^DD",9002313.02,9002313.02,103,21,3,0) B1=Billing "^DD",9002313.02,9002313.02,103,21,4,0) B2=Reversal "^DD",9002313.02,9002313.02,103,21,5,0) B3=Rebill "^DD",9002313.02,9002313.02,103,21,6,0) P1=P.A. Request & Billing "^DD",9002313.02,9002313.02,103,21,7,0) P2=P.A. Reversal "^DD",9002313.02,9002313.02,103,21,8,0) P3=P.A. Inquiry "^DD",9002313.02,9002313.02,103,21,9,0) P4=P.A. Request Only "^DD",9002313.02,9002313.02,103,21,10,0) N1=Information Reporting "^DD",9002313.02,9002313.02,103,21,11,0) N2=Information Reporting Reversal "^DD",9002313.02,9002313.02,103,21,12,0) N3=Information Reporting Rebill "^DD",9002313.02,9002313.02,103,21,13,0) C1=Controlled Substance Reporting "^DD",9002313.02,9002313.02,103,21,14,0) C2=Controlled Substance Reporting Reversal "^DD",9002313.02,9002313.02,103,21,15,0) C3=Controlled Substance Reporting Rebill "^DD",9002313.02,9002313.02,103,"DT") 3080102 "^DD",9002313.02,9002313.02,104,0) PROCESSOR CONTROL NUMBER^FJ10^^100;4^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.02,104,3) Answer must be 10 characters in length. "^DD",9002313.02,9002313.02,104,21,0) ^.001^2^2^3170614^^ "^DD",9002313.02,9002313.02,104,21,1,0) Number which will uniquely identify the submitter of the claim. NCPDP "^DD",9002313.02,9002313.02,104,21,2,0) field 104-A4. "^DD",9002313.02,9002313.02,104,"DT") 3170614 "^DD",9002313.02,9002313.02,109,0) TRANSACTION COUNT^F^^100;9^K:$L(X)>1!($L(X)<1) X "^DD",9002313.02,9002313.02,109,3) Answer must be 1 character in length. "^DD",9002313.02,9002313.02,109,21,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,109,21,1,0) Count of transactions in the transmission. NCPDP standard field 109-A9. "^DD",9002313.02,9002313.02,109,23,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,109,23,1,0) A transaction count of >1 is not allowed for Eligibility and Prior "^DD",9002313.02,9002313.02,109,23,2,0) Authorization transactions. REQUEST TRANSACTION HEADER SEGMENT. "^DD",9002313.02,9002313.02,109,"DT") 3080102 "^DD",9002313.02,9002313.02,110,0) SOFTWARE VENDOR/CERT ID^F^^100;10^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.02,110,3) Answer must be 10 characters in length. "^DD",9002313.02,9002313.02,110,21,0) ^^2^2^3080604^ "^DD",9002313.02,9002313.02,110,21,1,0) Certification number which Identifies the patient's insurance carrier. "^DD",9002313.02,9002313.02,110,21,2,0) NCPDP standard field 110-AK. "^DD",9002313.02,9002313.02,110,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,110,23,1,0) REQUEST TRANSACTION HEADER SEGMENT. "^DD",9002313.02,9002313.02,110,"DT") 3210329 "^DD",9002313.02,9002313.02,114,0) MEDICAID SUBROGATION ICN/TCN^F^^110;4^K:$L(X)>22!($L(X)<1) X "^DD",9002313.02,9002313.02,114,.1) MEDICAID SUBROGATION INTERNAL CONTROL NUMBER/TRANSACTION CONTROL NUMBER (ICN/TCN) "^DD",9002313.02,9002313.02,114,3) Answer must be 1-22 characters. "^DD",9002313.02,9002313.02,114,21,0) ^.001^2^2^3101019^^^^ "^DD",9002313.02,9002313.02,114,21,1,0) This is used to store NCPDP field 114-N4 (Medicaid Subrogation Internal Control Number/Transaction Control Number (ICN/TCN)), "^DD",9002313.02,9002313.02,114,21,2,0) which is defined as "Claim number assigned by the Medicaid Agency." "^DD",9002313.02,9002313.02,114,23,0) ^.001^2^2^3101019^^^^ "^DD",9002313.02,9002313.02,114,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.02,114,23,2,0) RESPONSE CLAIM SEGMENT. "^DD",9002313.02,9002313.02,114,"DT") 3101004 "^DD",9002313.02,9002313.02,115,0) MEDICAID ID NUMBER^F^^110;5^K:$L(X)>20!($L(X)<1) X "^DD",9002313.02,9002313.02,115,3) Answer must be 1-20 characters. "^DD",9002313.02,9002313.02,115,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,115,21,1,0) This is used to store NCPDP field 115-N5 (Medicaid ID Number), "^DD",9002313.02,9002313.02,115,21,2,0) which is defined as "A unique member identification number assigned by the Medicaid Agency." "^DD",9002313.02,9002313.02,115,23,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,115,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,115,23,2,0) RESPONSE INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,115,"DT") 3100831 "^DD",9002313.02,9002313.02,116,0) MEDICAID AGENCY NUMBER^F^^110;6^K:$L(X)>15!($L(X)<1) X "^DD",9002313.02,9002313.02,116,3) Answer must be 1-15 characters. "^DD",9002313.02,9002313.02,116,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,116,21,1,0) This is used to store NCPDP field 116-N6 (Medicaid Agency Number), "^DD",9002313.02,9002313.02,116,21,2,0) which is defined as "Number assigned by processor to identify the individual Medicaid Agency or representative." "^DD",9002313.02,9002313.02,116,23,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,116,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,116,23,2,0) RESPONSE INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,116,"DT") 3100831 "^DD",9002313.02,9002313.02,201,0) SERVICE PROVIDER ID^F^^200;1^K:$L(X)>15!($L(X)<15) X "^DD",9002313.02,9002313.02,201,3) Answer must be 15 characters in length "^DD",9002313.02,9002313.02,201,21,0) ^.001^1^1^3180524^^^ "^DD",9002313.02,9002313.02,201,21,1,0) ID assigned to a pharmacy or provider. NCPDP standard field 201-B1. "^DD",9002313.02,9002313.02,201,23,0) ^.001^2^2^3101001^^ "^DD",9002313.02,9002313.02,201,23,1,0) REQUEST TRANSACTION HEADER SEGMENT. "^DD",9002313.02,9002313.02,201,23,2,0) RESPONSE HEADER SEGMENT. "^DD",9002313.02,9002313.02,201,"DT") 3180524 "^DD",9002313.02,9002313.02,202,0) SERV PROVIDER ID QUALIFIER^F^^200;2^K:$L(X)>2!($L(X)<2) X "^DD",9002313.02,9002313.02,202,3) Answer must be 2 characters in length. "^DD",9002313.02,9002313.02,202,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,202,21,1,0) Qualifier indicating which ID number was used. NCPDP standard field "^DD",9002313.02,9002313.02,202,21,2,0) 202-B2. "^DD",9002313.02,9002313.02,202,23,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,202,23,1,0) REQUEST TRANSACTION HEADER SEGMENT. "^DD",9002313.02,9002313.02,202,23,2,0) RESPONSE HEADER SEGMENT. "^DD",9002313.02,9002313.02,202,"DT") 3210329 "^DD",9002313.02,9002313.02,301,0) GROUP ID^F^^300;1^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.02,301,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.02,301,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,301,21,1,0) ID assigned to the cardholder group or employer group. NCPDP standard "^DD",9002313.02,9002313.02,301,21,2,0) field 301-C1. "^DD",9002313.02,9002313.02,301,23,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,301,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,301,23,2,0) RESPONSE INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,301,"DT") 3080102 "^DD",9002313.02,9002313.02,302,0) CARDHOLDER ID^F^^300;2^K:$L(X)>20!($L(X)<2) X "^DD",9002313.02,9002313.02,302,3) Answer must be 2-20 characters in length "^DD",9002313.02,9002313.02,302,21,0) ^.001^2^2^3101020^^ "^DD",9002313.02,9002313.02,302,21,1,0) Insurance ID assigned to the cardholder or identification number used by "^DD",9002313.02,9002313.02,302,21,2,0) the plan. NCPDP standard field 302-C2. "^DD",9002313.02,9002313.02,302,23,0) ^.001^2^2^3101020^^ "^DD",9002313.02,9002313.02,302,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,302,23,2,0) RESPONSE INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,302,"DT") 3080102 "^DD",9002313.02,9002313.02,303,0) PERSON CODE^F^^300;3^K:$L(X)>5!($L(X)<5) X "^DD",9002313.02,9002313.02,303,3) Answer must be 5 characters in length "^DD",9002313.02,9002313.02,303,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,303,21,1,0) Code assigned to a specific person within a family. NCPDP standard field "^DD",9002313.02,9002313.02,303,21,2,0) 303-C3. "^DD",9002313.02,9002313.02,303,23,0) ^^8^8^3080102^ "^DD",9002313.02,9002313.02,303,23,1,0) Regarding the Telecommunication Standard: "^DD",9002313.02,9002313.02,303,23,2,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,303,23,3,0) - - - - - - - - - - - - - - - - - - - - - - - "^DD",9002313.02,9002313.02,303,23,4,0) Enrollment Standard Examples: "^DD",9002313.02,9002313.02,303,23,5,0) Examples: "^DD",9002313.02,9002313.02,303,23,6,0) 001=Cardholder "^DD",9002313.02,9002313.02,303,23,7,0) 002=Spouse "^DD",9002313.02,9002313.02,303,23,8,0) 003-999=Dependents and Others (including second spouses, etc.) "^DD",9002313.02,9002313.02,303,"DT") 3080102 "^DD",9002313.02,9002313.02,304,0) DATE OF BIRTH^F^^300;4^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.02,304,2) S Y(0)=Y S Y=$$FM3EXT^BPSOSU1(Y) "^DD",9002313.02,9002313.02,304,2.1) S Y=$$FM3EXT^BPSOSU1(Y) "^DD",9002313.02,9002313.02,304,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.02,304,21,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,304,21,1,0) Date of birth of patient. NCPDP standard field 304-C4. "^DD",9002313.02,9002313.02,304,23,0) ^^8^8^3080102^ "^DD",9002313.02,9002313.02,304,23,1,0) Format=CCYYMMDD "^DD",9002313.02,9002313.02,304,23,2,0) CC=Century "^DD",9002313.02,9002313.02,304,23,3,0) YY=Year "^DD",9002313.02,9002313.02,304,23,4,0) MM=Month "^DD",9002313.02,9002313.02,304,23,5,0) DD=Day "^DD",9002313.02,9002313.02,304,23,6,0) Examples: If a patient was born on July 27, 1970, this field would "^DD",9002313.02,9002313.02,304,23,7,0) reflect: 19700727. "^DD",9002313.02,9002313.02,304,23,8,0) REQUEST PATIENT SEGMENT. RESPONSE PATIENT SEGMENT. "^DD",9002313.02,9002313.02,304,"DT") 3080102 "^DD",9002313.02,9002313.02,305,0) PATIENT GENDER CODE^S^C50:NOT SPECIFIED;C51:MALE;C52:FEMALE;C53:NON-BINARY;^300;5^Q "^DD",9002313.02,9002313.02,305,3) Enter the patient's gender. "^DD",9002313.02,9002313.02,305,21,0) ^^3^3^3220331^ "^DD",9002313.02,9002313.02,305,21,1,0) Code indicating the gender of patient. "^DD",9002313.02,9002313.02,305,21,2,0) "^DD",9002313.02,9002313.02,305,21,3,0) NCPDP standard field 305-C5. "^DD",9002313.02,9002313.02,305,23,0) ^.001^1^1^3220331^^^ "^DD",9002313.02,9002313.02,305,23,1,0) REQUEST PATIENT SEGMENT. "^DD",9002313.02,9002313.02,305,"DT") 3220331 "^DD",9002313.02,9002313.02,306,0) PATIENT RELATIONSHIP CODE^FO^^300;6^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.02,306,2) S Y(0)=Y S Y=$S(Y="C60":"NOT SPECIFIED",Y="C61":"CARDHOLDER",Y="C62":"SPOUSE",Y="C63":"CHILD",Y="C64":"OTHER",1:Y) "^DD",9002313.02,9002313.02,306,2.1) S Y=$S(Y="C60":"NOT SPECIFIED",Y="C61":"CARDHOLDER",Y="C62":"SPOUSE",Y="C63":"CHILD",Y="C64":"OTHER",1:Y) "^DD",9002313.02,9002313.02,306,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.02,306,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,306,21,1,0) Code indicating relationship of patient to cardholder. NCPDP standard "^DD",9002313.02,9002313.02,306,21,2,0) field 306-C6. "^DD",9002313.02,9002313.02,306,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,306,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,306,"DT") 3110309 "^DD",9002313.02,9002313.02,307,0) PLACE OF SERVICE^F^^300;7^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.02,307,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.02,307,21,0) ^^15^15^3080102^ "^DD",9002313.02,9002313.02,307,21,1,0) Code identifying the location of the patient when receiving pharmacy "^DD",9002313.02,9002313.02,307,21,2,0) services. NCPDP standard field 307-C7. (was PATIENT LOCATION) "^DD",9002313.02,9002313.02,307,21,3,0) "^DD",9002313.02,9002313.02,307,21,4,0) Ø=Not Specified "^DD",9002313.02,9002313.02,307,21,5,0) 1=Home "^DD",9002313.02,9002313.02,307,21,6,0) 2=Inter-Care "^DD",9002313.02,9002313.02,307,21,7,0) 3=Nursing Home "^DD",9002313.02,9002313.02,307,21,8,0) 4=Long Term/Extended Care "^DD",9002313.02,9002313.02,307,21,9,0) 5=Rest Home "^DD",9002313.02,9002313.02,307,21,10,0) 6=Boarding Home "^DD",9002313.02,9002313.02,307,21,11,0) 7=Skilled Care Facility "^DD",9002313.02,9002313.02,307,21,12,0) 8=Sub-Acute Care Facility "^DD",9002313.02,9002313.02,307,21,13,0) 9=Acute Care Facility "^DD",9002313.02,9002313.02,307,21,14,0) 1Ø=Outpatient "^DD",9002313.02,9002313.02,307,21,15,0) 11=Hospice "^DD",9002313.02,9002313.02,307,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,307,23,1,0) REQUEST PATIENT SEGMENT. "^DD",9002313.02,9002313.02,307,"DT") 3080102 "^DD",9002313.02,9002313.02,309,0) ELIGIBILITY CLARIFICATION CODE^F^^300;9^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.02,309,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.02,309,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,309,21,1,0) Code indicating that the pharmacy is clarifying eligibility based on "^DD",9002313.02,9002313.02,309,21,2,0) receiving a denial. NCPDP standard field 309-C9. "^DD",9002313.02,9002313.02,309,23,0) ^^4^4^3080102^ "^DD",9002313.02,9002313.02,309,23,1,0) Examples: The patient has become a student but eligibility has not yet "^DD",9002313.02,9002313.02,309,23,2,0) been updated. The pharmacy can indicate "3" so that the carrier may "^DD",9002313.02,9002313.02,309,23,3,0) override eligibility for this patient. "^DD",9002313.02,9002313.02,309,23,4,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,309,"DT") 3080102 "^DD",9002313.02,9002313.02,310,0) PATIENT FIRST NAME^F^^300;10^K:$L(X)>14!($L(X)<14) X "^DD",9002313.02,9002313.02,310,3) Answer must be 14 characters in length "^DD",9002313.02,9002313.02,310,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,310,21,1,0) First name of patient receiving the prescription. NCPDP standard field "^DD",9002313.02,9002313.02,310,21,2,0) 310-CA. "^DD",9002313.02,9002313.02,310,23,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,310,23,1,0) REQUEST PATIENT SEGMENT. "^DD",9002313.02,9002313.02,310,23,2,0) RESPONSE PATIENT SEGMENT "^DD",9002313.02,9002313.02,310,"DT") 3191008 "^DD",9002313.02,9002313.02,311,0) PATIENT LAST NAME^F^^300;11^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.02,311,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.02,311,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,311,21,1,0) Last Name of patient receiving the prescription. NCPDP standard field "^DD",9002313.02,9002313.02,311,21,2,0) 311-CB. "^DD",9002313.02,9002313.02,311,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,311,23,1,0) REQUEST PATIENT SEGMENT. RESPONSE PATIENT SEGMENT "^DD",9002313.02,9002313.02,311,"DT") 3191008 "^DD",9002313.02,9002313.02,312,0) CARDHOLDER FIRST NAME^F^^300;12^K:$L(X)>14!($L(X)<14) X "^DD",9002313.02,9002313.02,312,3) Answer must be 14 characters in length "^DD",9002313.02,9002313.02,312,21,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,312,21,1,0) First name of the Cardholder/Subscriber. NCPDP standard field 312-CC. "^DD",9002313.02,9002313.02,312,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,312,23,1,0) REQUEST INSURANCE SEGMENT "^DD",9002313.02,9002313.02,312,"DT") 3080102 "^DD",9002313.02,9002313.02,313,0) CARDHOLDER LAST NAME^F^^300;13^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.02,313,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.02,313,21,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,313,21,1,0) Last name of the cardholder/subscriber. NCPDP standard field 313-CD. "^DD",9002313.02,9002313.02,313,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,313,23,1,0) REQUEST INSURANCE SEGMENT "^DD",9002313.02,9002313.02,313,"DT") 3080102 "^DD",9002313.02,9002313.02,314,0) HOME PLAN^F^^300;14^K:$L(X)>5!($L(X)<5) X "^DD",9002313.02,9002313.02,314,3) Answer must be 5 characters in length "^DD",9002313.02,9002313.02,314,21,0) ^^3^3^3080102^ "^DD",9002313.02,9002313.02,314,21,1,0) Code identifying the Blue Cross or Blue Shield plan ID which indicates "^DD",9002313.02,9002313.02,314,21,2,0) where the member's coverage has been designated. Usually where the member "^DD",9002313.02,9002313.02,314,21,3,0) lives or purchased their coverage. NCPDP standard field 314-CE. "^DD",9002313.02,9002313.02,314,23,0) ^^4^4^3080102^ "^DD",9002313.02,9002313.02,314,23,1,0) Used for interstate processing between Blue Cross and Blue Shield plans. "^DD",9002313.02,9002313.02,314,23,2,0) The Blue Cross codes are in the range less than 600 and Blue Shield codes "^DD",9002313.02,9002313.02,314,23,3,0) are greater than 599. "^DD",9002313.02,9002313.02,314,23,4,0) REQUEST INSURANCE SEGMENT "^DD",9002313.02,9002313.02,314,"DT") 3080102 "^DD",9002313.02,9002313.02,322,0) PATIENT STREET ADDRESS^F^^321;2^K:$L(X)>32!($L(X)<32) X "^DD",9002313.02,9002313.02,322,3) Answer must be 32 characters in length "^DD",9002313.02,9002313.02,322,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,322,21,1,0) Free-form text for Patient address information. NCPDP standard field "^DD",9002313.02,9002313.02,322,21,2,0) 322-CM. "^DD",9002313.02,9002313.02,322,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,322,23,1,0) REQUEST PATIENT SEGMENT "^DD",9002313.02,9002313.02,322,"DT") 3080102 "^DD",9002313.02,9002313.02,323,0) PATIENT CITY ADDRESS^F^^321;3^K:$L(X)>22!($L(X)<22) X "^DD",9002313.02,9002313.02,323,3) Answer must be 22 characters in length "^DD",9002313.02,9002313.02,323,21,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,323,21,1,0) Free-form text for city name. NCPDP standard field 323-CN. "^DD",9002313.02,9002313.02,323,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,323,23,1,0) REQUEST PATIENT SEGMENT "^DD",9002313.02,9002313.02,323,"DT") 3080102 "^DD",9002313.02,9002313.02,324,0) PATIENT STATE/PROVINCE ADDRESS^F^^321;4^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.02,324,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.02,324,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,324,21,1,0) Standard State/Province Code as defined by appropriate government "^DD",9002313.02,9002313.02,324,21,2,0) agency. NCPDP standard field 324-CO. "^DD",9002313.02,9002313.02,324,23,0) ^^3^3^3080102^ "^DD",9002313.02,9002313.02,324,23,1,0) Standard United States and Canadian province two-letter postal service "^DD",9002313.02,9002313.02,324,23,2,0) abbreviations should be used. "^DD",9002313.02,9002313.02,324,23,3,0) REQUEST PATIENT SEGMENT "^DD",9002313.02,9002313.02,324,"DT") 3210329 "^DD",9002313.02,9002313.02,325,0) PATIENT ZIP/POSTAL ZONE^F^^321;5^K:$L(X)>17!($L(X)<1) X "^DD",9002313.02,9002313.02,325,3) Answer must be 1-17 characters in length "^DD",9002313.02,9002313.02,325,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,325,21,1,0) Code defining international postal zone excluding punctuation and blanks "^DD",9002313.02,9002313.02,325,21,2,0) (zip code for US). NCPDP standard field 325-CP. "^DD",9002313.02,9002313.02,325,23,0) ^^9^9^3080102^ "^DD",9002313.02,9002313.02,325,23,1,0) This left-justified field contains the five-digit zip code, and may "^DD",9002313.02,9002313.02,325,23,2,0) include the four-digit expanded zip code in which the patient is located. "^DD",9002313.02,9002313.02,325,23,3,0) "^DD",9002313.02,9002313.02,325,23,4,0) Examples: If the zip code is 98765-4321, this field would reflect: "^DD",9002313.02,9002313.02,325,23,5,0) 987654321. "^DD",9002313.02,9002313.02,325,23,6,0) "^DD",9002313.02,9002313.02,325,23,7,0) If the zip code is 98765, this field would reflect: 98765 left justified. "^DD",9002313.02,9002313.02,325,23,8,0) "^DD",9002313.02,9002313.02,325,23,9,0) REQUEST PATIENT SEGMENT "^DD",9002313.02,9002313.02,325,"DT") 3210329 "^DD",9002313.02,9002313.02,326,0) PATIENT TELEPHONE NUMBER^F^^321;6^K:$L(X)>12!($L(X)<12) X "^DD",9002313.02,9002313.02,326,3) Answer must be 12 characters in length "^DD",9002313.02,9002313.02,326,21,0) ^.001^1^1^3141231^^ "^DD",9002313.02,9002313.02,326,21,1,0) Ten-digit phone number of patient. NCPDP standard field 326-CQ. "^DD",9002313.02,9002313.02,326,23,0) ^.001^9^9^3141231^^ "^DD",9002313.02,9002313.02,326,23,1,0) Format=AAAEEENNNN "^DD",9002313.02,9002313.02,326,23,2,0) AAA=Area Code "^DD",9002313.02,9002313.02,326,23,3,0) EEE=Exchange "^DD",9002313.02,9002313.02,326,23,4,0) NNNN=Number "^DD",9002313.02,9002313.02,326,23,5,0) "^DD",9002313.02,9002313.02,326,23,6,0) Examples: If the phone number is (313) 555-1212, this field would "^DD",9002313.02,9002313.02,326,23,7,0) reflect: 3135551212. "^DD",9002313.02,9002313.02,326,23,8,0) "^DD",9002313.02,9002313.02,326,23,9,0) REQUEST PATIENT SEGMENT "^DD",9002313.02,9002313.02,326,"DT") 3141231 "^DD",9002313.02,9002313.02,331,0) PATIENT ID QUALIFIER^F^^330;1^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.02,331,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.02,331,21,0) ^^7^7^3080102^ "^DD",9002313.02,9002313.02,331,21,1,0) Code qualifying the 'Patient ID'(332-CY). NCPDP standard field 331-CX. "^DD",9002313.02,9002313.02,331,21,2,0) "^DD",9002313.02,9002313.02,331,21,3,0) Blank=Not Specified "^DD",9002313.02,9002313.02,331,21,4,0) Ø1=Social Security Number "^DD",9002313.02,9002313.02,331,21,5,0) Ø2=Driver's License Number "^DD",9002313.02,9002313.02,331,21,6,0) Ø3=U.S. Military ID "^DD",9002313.02,9002313.02,331,21,7,0) 99=Other "^DD",9002313.02,9002313.02,331,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,331,23,1,0) REQUEST PATIENT SEGMENT "^DD",9002313.02,9002313.02,331,"DT") 3080102 "^DD",9002313.02,9002313.02,332,0) PATIENT ID^F^^330;2^K:$L(X)>22!($L(X)<22) X "^DD",9002313.02,9002313.02,332,3) Answer must be 22 characters in length "^DD",9002313.02,9002313.02,332,21,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,332,21,1,0) ID assigned to the patient. NCPDP standard field 332-CY. "^DD",9002313.02,9002313.02,332,23,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.02,332,23,1,0) Qualified by Patient Id Qualifier (331-CX). "^DD",9002313.02,9002313.02,332,23,2,0) REQUEST PATIENT SEGMENT "^DD",9002313.02,9002313.02,332,"DT") 3080102 "^DD",9002313.02,9002313.02,333,0) EMPLOYER ID^F^^330;3^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.02,333,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.02,333,21,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,333,21,1,0) ID assigned to employer. NCPDP standard field 333-CZ. "^DD",9002313.02,9002313.02,333,23,0) ^^6^6^3080102^ "^DD",9002313.02,9002313.02,333,23,1,0) The Internal Revenue Service, Department of the Treasury, assigns the "^DD",9002313.02,9002313.02,333,23,2,0) Employer ID. The format of this field is nine-digits with a hyphen, as "^DD",9002313.02,9002313.02,333,23,3,0) in 00-0000000. The hyphen must be transmitted as part of the Employer ID "^DD",9002313.02,9002313.02,333,23,4,0) Number. Information on the Employer ID may be found at "^DD",9002313.02,9002313.02,333,23,5,0) http://www.irs.ustreas.gov/. "^DD",9002313.02,9002313.02,333,23,6,0) REQUEST PATIENT SEGMENT "^DD",9002313.02,9002313.02,333,"DT") 3080102 "^DD",9002313.02,9002313.02,334,0) SMOKER/NONSMOKER^F^^330;4^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.02,334,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.02,334,21,0) ^^6^6^3080102^ "^DD",9002313.02,9002313.02,334,21,1,0) Code indicating the patient as a smoker or non-smoker. NCPDP standard "^DD",9002313.02,9002313.02,334,21,2,0) field 334-1C. "^DD",9002313.02,9002313.02,334,21,3,0) "^DD",9002313.02,9002313.02,334,21,4,0) Blank=Not Specified "^DD",9002313.02,9002313.02,334,21,5,0) 1=Non-Smoker "^DD",9002313.02,9002313.02,334,21,6,0) 2=Smoker "^DD",9002313.02,9002313.02,334,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,334,23,1,0) REQUEST PATIENT SEGMENT "^DD",9002313.02,9002313.02,334,"DT") 3210329 "^DD",9002313.02,9002313.02,335,0) PREGNANCY INDICATOR^F^^330;5^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.02,335,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.02,335,21,0) ^^6^6^3080102^ "^DD",9002313.02,9002313.02,335,21,1,0) Code indicating the patient as pregnant or non-pregnant. NCPDP standard "^DD",9002313.02,9002313.02,335,21,2,0) field 335-2C. "^DD",9002313.02,9002313.02,335,21,3,0) "^DD",9002313.02,9002313.02,335,21,4,0) Blank=Not Specified "^DD",9002313.02,9002313.02,335,21,5,0) 1=Not pregnant "^DD",9002313.02,9002313.02,335,21,6,0) 2=Pregnant "^DD",9002313.02,9002313.02,335,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.02,335,23,1,0) REQUEST PATIENT SEGMENT "^DD",9002313.02,9002313.02,335,"DT") 3080102 "^DD",9002313.02,9002313.02,336,0) FACILITY ID^FJ12^^330;6^K:$L(X)>12!($L(X)<12) X "^DD",9002313.02,9002313.02,336,3) Answer must be 12 characters in length. "^DD",9002313.02,9002313.02,336,21,0) ^.001^2^2^3170601^^ "^DD",9002313.02,9002313.02,336,21,1,0) ID assigned to the patient's clinic/host party. NCPDP standard field "^DD",9002313.02,9002313.02,336,21,2,0) 336-8C. "^DD",9002313.02,9002313.02,336,23,0) ^.001^1^1^3170601^^ "^DD",9002313.02,9002313.02,336,23,1,0) REQUEST INSURANCE SEGMENT "^DD",9002313.02,9002313.02,336,"DT") 3170601 "^DD",9002313.02,9002313.02,350,0) PATIENT E-MAIL ADDRESS^F^^340;10^K:$L(X)>82!($L(X)<1) X "^DD",9002313.02,9002313.02,350,3) Answer must be 1-82 characters in length. "^DD",9002313.02,9002313.02,350,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,350,21,1,0) This is used to store NCPDP field 350-HN (Patient E-Mail Address), "^DD",9002313.02,9002313.02,350,21,2,0) which is defined as "The E-Mail address of the patient (member)." "^DD",9002313.02,9002313.02,350,"DT") 3100727 "^DD",9002313.02,9002313.02,356,0) OTHER PAYER CARDHOLDER ID^F^^350;6^K:$L(X)>22!($L(X)<1) X "^DD",9002313.02,9002313.02,356,3) Answer must be 1-22 characters. "^DD",9002313.02,9002313.02,356,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,356,21,1,0) This is used to store NCPDP field 356-NU (Other Payer Cardholder ID), "^DD",9002313.02,9002313.02,356,21,2,0) which is defined as "Cardholder ID for this member that is associated with the Payer noted." "^DD",9002313.02,9002313.02,356,23,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,356,23,1,0) RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT. "^DD",9002313.02,9002313.02,356,23,2,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,356,"DT") 3100831 "^DD",9002313.02,9002313.02,359,0) MEDIGAP ID^F^^350;9^K:$L(X)>22!($L(X)<1) X "^DD",9002313.02,9002313.02,359,3) Answer must be 1-22 characters. "^DD",9002313.02,9002313.02,359,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,359,21,1,0) This is used to store NCPDP field 359-2A (Medigap ID), "^DD",9002313.02,9002313.02,359,21,2,0) which is defined as "Patient's ID assigned by the Medigap Insurer." "^DD",9002313.02,9002313.02,359,23,0) ^.001^1^1^3101004^^^^ "^DD",9002313.02,9002313.02,359,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,359,"DT") 3100831 "^DD",9002313.02,9002313.02,360,0) MEDICAID INDICATOR^F^^350;10^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.02,360,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.02,360,21,0) ^.001^2^2^3101007^^ "^DD",9002313.02,9002313.02,360,21,1,0) This is used to store NCPDP field 360-2B (Medicaid Indicator), "^DD",9002313.02,9002313.02,360,21,2,0) which is defined as "Two character State Postal Code indicating the state where Medicaid coverage exists." "^DD",9002313.02,9002313.02,360,23,0) ^^1^1^3101007^ "^DD",9002313.02,9002313.02,360,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,360,"DT") 3101007 "^DD",9002313.02,9002313.02,361,0) PROVIDER ACCEPT ASSGNMT INDCTR^F^^360;1^K:$L(X)>3!($L(X)<1) X "^DD",9002313.02,9002313.02,361,.1) PROVIDER ACCEPT ASSIGNMENT INDICATOR "^DD",9002313.02,9002313.02,361,3) Answer must be 1-3 characters. "^DD",9002313.02,9002313.02,361,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,361,21,1,0) This is used to store NCPDP field 361-2D (Provider Accept Assignment Indicator), "^DD",9002313.02,9002313.02,361,21,2,0) which is defined as "Code indicating whether the provider accepts assignment." "^DD",9002313.02,9002313.02,361,23,0) ^.001^1^1^3101004^^^ "^DD",9002313.02,9002313.02,361,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,361,"DT") 3100901 "^DD",9002313.02,9002313.02,384,0) PATIENT RESIDENCE^F^^380;4^K:$L(X)>2!($L(X)<1) X "^DD",9002313.02,9002313.02,384,3) Answer must be 1-2 characters. "^DD",9002313.02,9002313.02,384,21,0) 3^.001^2^2^3100929^^ "^DD",9002313.02,9002313.02,384,21,1,0) This is used to store NCPDP field 384-4X (Patient Residence), "^DD",9002313.02,9002313.02,384,21,2,0) which is defined as "Code identifying the patient's place of residence." "^DD",9002313.02,9002313.02,384,"DT") 3100727 "^DD",9002313.02,9002313.02,400,0) TRANSACTIONS^9002313.0201A^^400;0 "^DD",9002313.02,9002313.02,400,"DT") 3100922 "^DD",9002313.02,9002313.02,401,0) DATE OF SERVICE^F^^401;1^K:$L(X)>8!($L(X)<8) X "^DD",9002313.02,9002313.02,401,1,0) ^.1 "^DD",9002313.02,9002313.02,401,1,1,0) 9002313.02^AF "^DD",9002313.02,9002313.02,401,1,1,1) S ^BPSC("AF",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.02,401,1,1,2) K ^BPSC("AF",$E(X,1,30),DA) "^DD",9002313.02,9002313.02,401,1,1,"DT") 2950724 "^DD",9002313.02,9002313.02,401,3) Answer must be 8 characters in length "^DD",9002313.02,9002313.02,401,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.02,401,21,1,0) Date prescription was dispensed. NCPDP standard field 401-D1. "^DD",9002313.02,9002313.02,401,23,0) ^^12^12^3080104^ "^DD",9002313.02,9002313.02,401,23,1,0) Format=CCYYMMDD "^DD",9002313.02,9002313.02,401,23,2,0) "^DD",9002313.02,9002313.02,401,23,3,0) CC=Century "^DD",9002313.02,9002313.02,401,23,4,0) YY=Year "^DD",9002313.02,9002313.02,401,23,5,0) MM=Month "^DD",9002313.02,9002313.02,401,23,6,0) DD=Day "^DD",9002313.02,9002313.02,401,23,7,0) "^DD",9002313.02,9002313.02,401,23,8,0) Examples: If the prescription was dispensed on April 22, 2000, this field "^DD",9002313.02,9002313.02,401,23,9,0) would reflect 20000422. "^DD",9002313.02,9002313.02,401,23,10,0) "^DD",9002313.02,9002313.02,401,23,11,0) REQUEST TRANSACTION HEADER SEGMENT. "^DD",9002313.02,9002313.02,401,23,12,0) RESPONSE HEADER SEGMENT. "^DD",9002313.02,9002313.02,401,"DT") 3080604 "^DD",9002313.02,9002313.02,524,0) PLAN ID^F^^520;4^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.02,524,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.02,524,21,0) ^^3^3^3080104^ "^DD",9002313.02,9002313.02,524,21,1,0) Assigned by the processor to identify a set of parameters, benefit, or "^DD",9002313.02,9002313.02,524,21,2,0) coverage criteria used to adjudicate a claim. NCPDP standard field "^DD",9002313.02,9002313.02,524,21,3,0) 524-FO. "^DD",9002313.02,9002313.02,524,23,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.02,524,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,524,23,2,0) RESPONSE INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,524,"DT") 3080104 "^DD",9002313.02,9002313.02,618,0) PATIENT ID COUNT^NJ1,0^^610;8^K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X "^DD",9002313.02,9002313.02,618,3) Type a number between 0 and 9, 0 decimal digits. "^DD",9002313.02,9002313.02,618,21,0) ^^1^1^3191008^ "^DD",9002313.02,9002313.02,618,21,1,0) Count of patient ID occurrences. NCPDP standard field 618-RR. "^DD",9002313.02,9002313.02,618,"DT") 3191008 "^DD",9002313.02,9002313.02,901,0) CLOSED^S^0:NO;1:YES;^900;1^Q "^DD",9002313.02,9002313.02,901,3) Enter if this claim is closed or not. "^DD",9002313.02,9002313.02,901,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.02,901,21,1,0) Specify if the claim has been closed (no longer needed for followup) or "^DD",9002313.02,9002313.02,901,21,2,0) not. "^DD",9002313.02,9002313.02,901,"DT") 3190214 "^DD",9002313.02,9002313.02,902,0) DATE CLOSED^D^^900;2^S %DT="ESTX" D ^%DT S X=Y K:X<1 X "^DD",9002313.02,9002313.02,902,1,0) ^.1 "^DD",9002313.02,9002313.02,902,1,1,0) 9002313.02^AG "^DD",9002313.02,9002313.02,902,1,1,1) S ^BPSC("AG",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.02,902,1,1,2) K ^BPSC("AG",$E(X,1,30),DA) "^DD",9002313.02,9002313.02,902,1,1,"DT") 3040518 "^DD",9002313.02,9002313.02,902,3) Enter the date this claim was closed. "^DD",9002313.02,9002313.02,902,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.02,902,21,1,0) This is automatically populated with the date a claim was closed. "^DD",9002313.02,9002313.02,902,"DT") 3080104 "^DD",9002313.02,9002313.02,903,0) CLOSED BY^P200'^VA(200,^900;3^Q "^DD",9002313.02,9002313.02,903,3) Enter the person who closed this claim. "^DD",9002313.02,9002313.02,903,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.02,903,21,1,0) This is automatically populated with the user who closed the claim. "^DD",9002313.02,9002313.02,903,"DT") 3080104 "^DD",9002313.02,9002313.02,904,0) CLOSED REASON^*P356.8'^IBE(356.8,^900;4^S DIC("S")="I $P(^IBE(356.8,+Y,0),U,2)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X "^DD",9002313.02,9002313.02,904,3) Enter the Claim Close Reason. "^DD",9002313.02,9002313.02,904,12) Only ECME-supported non-billable reasons can be entered. "^DD",9002313.02,9002313.02,904,12.1) S DIC("S")="I $P(^IBE(356.8,+Y,0),U,2)" "^DD",9002313.02,9002313.02,904,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.02,904,21,1,0) The ECME-supported non-billable reason entered by the user or defaulted by "^DD",9002313.02,9002313.02,904,21,2,0) the system. "^DD",9002313.02,9002313.02,904,"DT") 3080104 "^DD",9002313.02,9002313.02,905,0) DROP TO PAPER^S^D:DROP TO PAPER;N:NON-BILLABLE;^900;5^Q "^DD",9002313.02,9002313.02,905,3) Enter D if this claim should be billed on a paper claim. "^DD",9002313.02,9002313.02,905,21,0) ^.001^4^4^3050518^^^ "^DD",9002313.02,9002313.02,905,21,1,0) If close reason is 90 DAY RX FILL NOT COVERED or "^DD",9002313.02,9002313.02,905,21,2,0) NOT A CONTRACTED PROVIDER then user will be prompted: "^DD",9002313.02,9002313.02,905,21,3,0) Treat as (N)on-Billable Episode or (D)rop Bill to Paper? "^DD",9002313.02,9002313.02,905,21,4,0) the answer is stored in this field and sent to IB "^DD",9002313.02,9002313.02,905,"DT") 3080104 "^DD",9002313.02,9002313.02,906,0) DATE REOPENED^D^^900;6^S %DT="E" D ^%DT S X=Y K:Y<1 X "^DD",9002313.02,9002313.02,906,3) Enter the date and time when the claim was re-opened "^DD",9002313.02,9002313.02,906,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.02,906,21,1,0) Date and time when the claim was re-opened. "^DD",9002313.02,9002313.02,906,"DT") 3080104 "^DD",9002313.02,9002313.02,907,0) REOPENED BY^P200'^VA(200,^900;7^Q "^DD",9002313.02,9002313.02,907,3) Enter the user who re-opened the claim "^DD",9002313.02,9002313.02,907,21,0) ^^1^1^3060523^ "^DD",9002313.02,9002313.02,907,21,1,0) The system user who re-opened the claim. "^DD",9002313.02,9002313.02,907,"DT") 3060614 "^DD",9002313.02,9002313.02,908,0) REOPENED COMMENT^F^^900;8^K:$L(X)>40!($L(X)<1) X "^DD",9002313.02,9002313.02,908,3) Enter the reason for the re-opening of the claim "^DD",9002313.02,9002313.02,908,21,0) ^^1^1^3060614^ "^DD",9002313.02,9002313.02,908,21,1,0) User comments for the re-opening of the claim. "^DD",9002313.02,9002313.02,908,"DT") 3060614 "^DD",9002313.02,9002313.02,990,0) OTHER PAYER BIN NUMBER^F^^980;10^K:$L(X)>8!($L(X)<1) X "^DD",9002313.02,9002313.02,990,3) Answer must be 1-8 characters. "^DD",9002313.02,9002313.02,990,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,990,21,1,0) This is used to store NCPDP field 990-MG (Other Payer BIN Number), "^DD",9002313.02,9002313.02,990,21,2,0) which is defined as "The secondary, tertiary, etc. card issuer or bank ID number used for network routing." "^DD",9002313.02,9002313.02,990,23,0) ^.001^1^1^3101004^^^^ "^DD",9002313.02,9002313.02,990,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,990,"DT") 3100831 "^DD",9002313.02,9002313.02,991,0) OTHER PAYER PROC CONTROL NUM^F^^990;1^K:$L(X)>12!($L(X)<1) X "^DD",9002313.02,9002313.02,991,.1) OTHER PAYER PROCESSOR CONTROL NUMBER "^DD",9002313.02,9002313.02,991,3) Answer must be 1-12 characters. "^DD",9002313.02,9002313.02,991,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,991,21,1,0) This is used to store NCPDP field 991-MH (Other Payer Processor Control Number), "^DD",9002313.02,9002313.02,991,21,2,0) which is defined as "A number that uniquely identifies the secondary, tertiary, etc. payer to the processor." "^DD",9002313.02,9002313.02,991,23,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,991,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,991,23,2,0) RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT. "^DD",9002313.02,9002313.02,991,"DT") 3210329 "^DD",9002313.02,9002313.02,992,0) OTHER PAYER GROUP ID^F^^990;2^K:$L(X)>17!($L(X)<1) X "^DD",9002313.02,9002313.02,992,3) Answer must be 1-17 characters. "^DD",9002313.02,9002313.02,992,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,992,21,1,0) This is used to store NCPDP field 992-MJ (Other Payer Group ID), "^DD",9002313.02,9002313.02,992,21,2,0) which is defined as "ID assigned to the cardholder group or employer group by the secondary, tertiary, etc. payer." "^DD",9002313.02,9002313.02,992,23,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,992,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,992,23,2,0) RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT. "^DD",9002313.02,9002313.02,992,"DT") 3100831 "^DD",9002313.02,9002313.02,997,0) CMS PART D DEFND QLFD FACILITY^F^^990;7^K:$L(X)>3!($L(X)<1) X "^DD",9002313.02,9002313.02,997,.1) CMS PART D DEFINED QUALIFIED FACILITY "^DD",9002313.02,9002313.02,997,3) Answer must be 1-3 characters. "^DD",9002313.02,9002313.02,997,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02,997,21,1,0) This is used to store NCPDP field 997-G2 (CMS Part D Defined Qualified Facility), "^DD",9002313.02,9002313.02,997,21,2,0) which is defined as "Indicates that the patient resides in a facility that qualifies for the CMS Part D benefit." "^DD",9002313.02,9002313.02,997,23,0) ^.001^1^1^3101004^^^ "^DD",9002313.02,9002313.02,997,23,1,0) REQUEST INSURANCE SEGMENT. "^DD",9002313.02,9002313.02,997,"DT") 3210329 "^DD",9002313.02,9002313.02,1022,0) PATIENT ID STATE/PROVINCE^F^^A20;2^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.02,1022,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.02,1022,21,0) ^^5^5^3130301^ "^DD",9002313.02,9002313.02,1022,21,1,0) NCPDP Standard field A22-YR "^DD",9002313.02,9002313.02,1022,21,2,0) "^DD",9002313.02,9002313.02,1022,21,3,0) The postal state code abbreviation that is used in conjunction with the "^DD",9002313.02,9002313.02,1022,21,4,0) Patient ID Qualifier and the Patient ID fields to identify what state the "^DD",9002313.02,9002313.02,1022,21,5,0) identification is from. "^DD",9002313.02,9002313.02,1022,23,0) ^^1^1^3130227^ "^DD",9002313.02,9002313.02,1022,23,1,0) PATIENT SEGMENT "^DD",9002313.02,9002313.02,1022,"DT") 3130301 "^DD",9002313.02,9002313.02,1043,0) PATIENT COUNTRY CODE^F^^A40;3^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.02,1043,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.02,1043,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.02,1043,21,1,0) NCPDP Standard field A43-1K "^DD",9002313.02,9002313.02,1043,21,2,0) "^DD",9002313.02,9002313.02,1043,21,3,0) The country of the patient's permanent residence. "^DD",9002313.02,9002313.02,1043,23,0) ^^1^1^3130227^ "^DD",9002313.02,9002313.02,1043,23,1,0) PATIENT SEGMENT "^DD",9002313.02,9002313.02,1043,"DT") 3130301 "^DD",9002313.02,9002313.02,1045,0) VETERINARY USE INDICATOR^F^^A40;5^K:$L(X)>3!($L(X)<1) X "^DD",9002313.02,9002313.02,1045,3) Answer must be 1-3 characters in length. "^DD",9002313.02,9002313.02,1045,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.02,1045,21,1,0) NCPDP Standard field A45-1R "^DD",9002313.02,9002313.02,1045,21,2,0) "^DD",9002313.02,9002313.02,1045,21,3,0) To indicate that the prescription was dispensed for use on something "^DD",9002313.02,9002313.02,1045,21,4,0) other than human. "^DD",9002313.02,9002313.02,1045,23,0) ^^1^1^3130227^ "^DD",9002313.02,9002313.02,1045,23,1,0) PATIENT SEGMENT "^DD",9002313.02,9002313.02,1045,"DT") 3130301 "^DD",9002313.02,9002313.02,2008,0) PATIENT STREET ADDRESS LINE 1^F^^B00;8^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.02,2008,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.02,2008,21,0) ^^2^2^3170228^^ "^DD",9002313.02,9002313.02,2008,21,1,0) This is used to store NCPDP field B08-7A (Patient Street Address Line 1), "^DD",9002313.02,9002313.02,2008,21,2,0) which is defined as "Free-form text for address line 1 information". "^DD",9002313.02,9002313.02,2008,"DT") 3170228 "^DD",9002313.02,9002313.02,2009,0) PATIENT STREET ADDRESS LINE 2^F^^B00;9^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.02,2009,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.02,2009,21,0) ^^2^2^3141223^ "^DD",9002313.02,9002313.02,2009,21,1,0) This is used to store NCPDP field B09-7B (Patient Street Address Line 2), "^DD",9002313.02,9002313.02,2009,21,2,0) which is defined as "Free-form text for address line 2 information". "^DD",9002313.02,9002313.02,2009,"DT") 3141231 "^DD",9002313.02,9002313.02,2038,0) PATIENT ID ASSOC COUNTRY CODE^F^^B30;8^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.02,2038,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.02,2038,21,0) ^^2^2^3141231^ "^DD",9002313.02,9002313.02,2038,21,1,0) This is used to store NCPDP field B38-1Y (Patient ID Associated Country "^DD",9002313.02,9002313.02,2038,21,2,0) Code), which is defined as "Code of the country". "^DD",9002313.02,9002313.02,2038,"DT") 3141231 "^DD",9002313.02,9002313.02,2306,0) SPECIES^FJ9^^E00;6^K:$L(X)>9!($L(X)<1) X "^DD",9002313.02,9002313.02,2306,3) Answer must be 1-9 characters in length. "^DD",9002313.02,9002313.02,2306,21,0) ^^1^1^3191008^ "^DD",9002313.02,9002313.02,2306,21,1,0) Species. Not used for humans. NCPDP standard field E06-S8. "^DD",9002313.02,9002313.02,2306,"DT") 3191008 "^DD",9002313.02,9002313.02,2309,0) PATIENT MIDDLE NAME^FJ25^^E00;9^K:$L(X)>25!($L(X)<1) X "^DD",9002313.02,9002313.02,2309,3) Answer must be 1-25 characters in length. "^DD",9002313.02,9002313.02,2309,21,0) ^^1^1^3191008^ "^DD",9002313.02,9002313.02,2309,21,1,0) Patient middle name. NCPDP standard field E09-0C. "^DD",9002313.02,9002313.02,2309,"DT") 3191008 "^DD",9002313.02,9002313.02,2310,0) PATIENT NAME PREFIX^FJ10^^E00;10^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.02,2310,3) Answer must be 1-10 characters in length. "^DD",9002313.02,9002313.02,2310,21,0) ^^1^1^3191008^ "^DD",9002313.02,9002313.02,2310,21,1,0) Patient name prefix. NCPDP standard field E10-0D. "^DD",9002313.02,9002313.02,2310,"DT") 3191008 "^DD",9002313.02,9002313.02,2311,0) PATIENT NAME SUFFIX^FJ10^^E10;1^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.02,2311,3) Answer must be 1-10 characters in length. "^DD",9002313.02,9002313.02,2311,21,0) ^^1^1^3191008^ "^DD",9002313.02,9002313.02,2311,21,1,0) Patient name suffix. NCPDP standard field E11-0E. "^DD",9002313.02,9002313.02,2311,"DT") 3191008 "^DD",9002313.02,9002313.02,9999,0) RAW DATA SENT^9002313.29999^^M;0 "^DD",9002313.02,9002313.02,9999,3) Enter the Raw data transmitted to the payer. "^DD",9002313.02,9002313.02,9999,21,0) ^^1^1^3040331^ "^DD",9002313.02,9002313.02,9999,21,1,0) An exact copy of the record sent via the communications protocol. "^DD",9002313.02,9002313.0201,0) TRANSACTIONS SUB-FIELD^NL^2432^245 "^DD",9002313.02,9002313.0201,0,"DT") 3220127 "^DD",9002313.02,9002313.0201,0,"IX","B",9002313.0201,.01) "^DD",9002313.02,9002313.0201,0,"NM","TRANSACTIONS") "^DD",9002313.02,9002313.0201,0,"UP") 9002313.02 "^DD",9002313.02,9002313.0201,.01,0) TRANSACTION ORDER^MNJ9,0^^0;1^K:+X'=X!(X>999999999)!(X<1)!(X?.E1"."1.N) X "^DD",9002313.02,9002313.0201,.01,1,0) ^.1 "^DD",9002313.02,9002313.0201,.01,1,1,0) 9002313.0201^B "^DD",9002313.02,9002313.0201,.01,1,1,1) S ^BPSC(DA(1),400,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.0201,.01,1,1,2) K ^BPSC(DA(1),400,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.0201,.01,3) Type a number between 1 and 999999999, 0 decimal digits. "^DD",9002313.02,9002313.0201,.01,21,0) ^^3^3^3101022^ "^DD",9002313.02,9002313.0201,.01,21,1,0) This is the numeric value to indicate the order of the transactions. This "^DD",9002313.02,9002313.0201,.01,21,2,0) is a sequential value starting at 1 to store multiple transactions on "^DD",9002313.02,9002313.0201,.01,21,3,0) this request. "^DD",9002313.02,9002313.0201,.01,"DT") 3180516 "^DD",9002313.02,9002313.0201,.04,0) MEDICATION NAME^F^^0;4^K:$L(X)>50!($L(X)<1) X "^DD",9002313.02,9002313.0201,.04,3) Answer must be 1-50 characters in length. "^DD",9002313.02,9002313.0201,.04,21,0) ^^1^1^3031125^ "^DD",9002313.02,9002313.0201,.04,21,1,0) Name of the med ordered. "^DD",9002313.02,9002313.0201,.04,"DT") 3080102 "^DD",9002313.02,9002313.0201,.05,0) PRESCRIPTION NUMBER^P52'^PSRX(^0;5^Q "^DD",9002313.02,9002313.0201,.05,3) Enter the Prescription for this medication "^DD",9002313.02,9002313.0201,.05,21,0) ^^1^1^3070227^ "^DD",9002313.02,9002313.0201,.05,21,1,0) This is the prescription associated with the claim "^DD",9002313.02,9002313.0201,.05,"DT") 3080102 "^DD",9002313.02,9002313.0201,113,0) MEDICAID PAID AMOUNT^F^^110;3^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.0201,113,3) Answer must be 1-10 characters. "^DD",9002313.02,9002313.0201,113,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.0201,113,21,1,0) This is used to store NCPDP field 113-N3 (Medicaid Paid Amount), "^DD",9002313.02,9002313.0201,113,21,2,0) which is defined as "Amount paid by the Medicaid Agency." "^DD",9002313.02,9002313.0201,113,23,0) ^^1^1^3100901^ "^DD",9002313.02,9002313.0201,113,23,1,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,113,"DT") 3100901 "^DD",9002313.02,9002313.0201,117,0) BILLING ENTITY TYPE INDICATOR^F^^110;7^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,117,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.0201,117,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.0201,117,21,1,0) This is used to store NCPDP field 117-TR (Billing Entity Type Indicator), "^DD",9002313.02,9002313.0201,117,21,2,0) which is defined as "A code that identifies the entity submitting the billing transaction." "^DD",9002313.02,9002313.0201,117,23,0) ^^1^1^3100901^ "^DD",9002313.02,9002313.0201,117,23,1,0) REQUEST WORKERS' COMPENSATION SEGMENT. "^DD",9002313.02,9002313.0201,117,"DT") 3100901 "^DD",9002313.02,9002313.0201,118,0) PAY TO QUALIFIER^F^^110;8^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,118,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.0201,118,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.0201,118,21,1,0) This is used to store NCPDP field 118-TS (Pay To Qualifier), "^DD",9002313.02,9002313.0201,118,21,2,0) which is defined as "Code qualifying the Pay To ID (119-TT)." "^DD",9002313.02,9002313.0201,118,23,0) ^^1^1^3100901^ "^DD",9002313.02,9002313.0201,118,23,1,0) REQUEST WORKERS' COMPENSATION SEGMENT. "^DD",9002313.02,9002313.0201,118,"DT") 3100901 "^DD",9002313.02,9002313.0201,119,0) PAY TO ID^F^^110;9^K:$L(X)>17!($L(X)<1) X "^DD",9002313.02,9002313.0201,119,3) Answer must be 1-17 characters. "^DD",9002313.02,9002313.0201,119,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.0201,119,21,1,0) This is used to store NCPDP field 119-TT (Pay To ID), "^DD",9002313.02,9002313.0201,119,21,2,0) which is defined as "Identifying number of the entity to receive payment for claim." "^DD",9002313.02,9002313.0201,119,23,0) ^^1^1^3100901^ "^DD",9002313.02,9002313.0201,119,23,1,0) REQUEST WORKERS' COMPENSATION SEGMENT. "^DD",9002313.02,9002313.0201,119,"DT") 3100901 "^DD",9002313.02,9002313.0201,120,0) PAY TO NAME^F^^110;10^K:$L(X)>22!($L(X)<1) X "^DD",9002313.02,9002313.0201,120,3) Answer must be 1-22 characters. "^DD",9002313.02,9002313.0201,120,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.0201,120,21,1,0) This is used to store NCPDP field 120-TU (Pay To Name), "^DD",9002313.02,9002313.0201,120,21,2,0) which is defined as "Name of the entity to receive payment for claim." "^DD",9002313.02,9002313.0201,120,23,0) ^^1^1^3100901^ "^DD",9002313.02,9002313.0201,120,23,1,0) REQUEST WORKERS' COMPENSATION SEGMENT. "^DD",9002313.02,9002313.0201,120,"DT") 3210331 "^DD",9002313.02,9002313.0201,121,0) PAY TO STREET ADDRESS^F^^120;1^K:$L(X)>32!($L(X)<1) X "^DD",9002313.02,9002313.0201,121,3) Answer must be 1-32 characters. "^DD",9002313.02,9002313.0201,121,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.0201,121,21,1,0) This is used to store NCPDP field 121-TV (Pay To Street Address), "^DD",9002313.02,9002313.0201,121,21,2,0) which is defined as "Street address of the entity to receive payment for claim." "^DD",9002313.02,9002313.0201,121,23,0) ^^1^1^3100901^ "^DD",9002313.02,9002313.0201,121,23,1,0) REQUEST WORKERS' COMPENSATION SEGMENT. "^DD",9002313.02,9002313.0201,121,"DT") 3100901 "^DD",9002313.02,9002313.0201,122,0) PAY TO CITY ADDRESS^F^^120;2^K:$L(X)>22!($L(X)<1) X "^DD",9002313.02,9002313.0201,122,3) Answer must be 1-22 characters. "^DD",9002313.02,9002313.0201,122,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.0201,122,21,1,0) This is used to store NCPDP field 122-TW (Pay To City Address), "^DD",9002313.02,9002313.0201,122,21,2,0) which is defined as "City of the entity to receive payment for claim." "^DD",9002313.02,9002313.0201,122,23,0) ^^1^1^3100901^ "^DD",9002313.02,9002313.0201,122,23,1,0) REQUEST WORKERS' COMPENSATION SEGMENT. "^DD",9002313.02,9002313.0201,122,"DT") 3100901 "^DD",9002313.02,9002313.0201,123,0) PAY TO STATE/PROVINCE ADDRESS^F^^120;3^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,123,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.0201,123,21,0) ^.001^1^1^3100929^^^ "^DD",9002313.02,9002313.0201,123,21,1,0) This is used to store NCPDP field 123-TX (Pay to State/Province Address). "^DD",9002313.02,9002313.0201,123,23,0) ^.001^1^1^3100929^^ "^DD",9002313.02,9002313.0201,123,23,1,0) REQUEST WORKERS' COMPENSATION SEGMENT. "^DD",9002313.02,9002313.0201,123,"DT") 3100901 "^DD",9002313.02,9002313.0201,124,0) PAY TO ZIP/POSTAL ZONE^F^^120;4^K:$L(X)>17!($L(X)<1) X "^DD",9002313.02,9002313.0201,124,3) Answer must be 1-17 characters. "^DD",9002313.02,9002313.0201,124,21,0) ^.001^2^2^3100929^^^ "^DD",9002313.02,9002313.0201,124,21,1,0) This is used to store NCPDP field 124-TY (Pay To Zip/Postal Zone), "^DD",9002313.02,9002313.0201,124,21,2,0) which is defined as "Code defining international postal zone excluding punctuation and blanks (zip code for US)." "^DD",9002313.02,9002313.0201,124,23,0) ^.001^3^3^3100929^^ "^DD",9002313.02,9002313.0201,124,23,1,0) Examples: If the zip code is 98765-4321, this field would reflect: 987654321. "^DD",9002313.02,9002313.0201,124,23,2,0) If the zip code is 98765, this field would reflect: 98765 left justified. "^DD",9002313.02,9002313.0201,124,23,3,0) REQUEST WORKERS' COMPENSATION SEGMENT. "^DD",9002313.02,9002313.0201,124,"DT") 3100901 "^DD",9002313.02,9002313.0201,125,0) GENERIC EQUIV PROD ID QLFR^F^^120;5^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,125,.1) GENERIC EQUIVALENT PRODUCT ID QUALIFIER "^DD",9002313.02,9002313.0201,125,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.0201,125,21,0) ^.001^2^2^3100929^^^ "^DD",9002313.02,9002313.0201,125,21,1,0) This is used to store NCPDP field 125-TZ (Generic Equivalent Product ID Qualifier), "^DD",9002313.02,9002313.0201,125,21,2,0) which is defined as "Code qualifying the Generic Equivalent Product ID (126-UA)." "^DD",9002313.02,9002313.0201,125,23,0) ^.001^2^2^3100929^^ "^DD",9002313.02,9002313.0201,125,23,1,0) Comments: Qualifies Generic Equivalent Product ID (126-UA). "^DD",9002313.02,9002313.0201,125,23,2,0) REQUEST WORKERS' COMPENSATION SEGMENT. "^DD",9002313.02,9002313.0201,125,"DT") 3210422 "^DD",9002313.02,9002313.0201,126,0) GENERIC EQUIVALENT PRODUCT ID^F^^120;6^K:$L(X)>21!($L(X)<1) X "^DD",9002313.02,9002313.0201,126,3) Answer must be 1-21 characters. "^DD",9002313.02,9002313.0201,126,21,0) ^.001^2^2^3100929^^^ "^DD",9002313.02,9002313.0201,126,21,1,0) This is used to store NCPDP field 126-UA (Generic Equivalent Product ID), "^DD",9002313.02,9002313.0201,126,21,2,0) which is defined as "Identifies the generic equivalent of the brand product dispensed." "^DD",9002313.02,9002313.0201,126,23,0) ^.001^3^3^3100929^^ "^DD",9002313.02,9002313.0201,126,23,1,0) Comments: Qualified by Generic Equivalent Product ID Qualifier (125-TZ). "^DD",9002313.02,9002313.0201,126,23,2,0) Qualifier (118-TS). "^DD",9002313.02,9002313.0201,126,23,3,0) REQUEST WORKERS' COMPENSATION SEGMENT. "^DD",9002313.02,9002313.0201,126,"DT") 3100901 "^DD",9002313.02,9002313.0201,147,0) PHARMACY SERVICE TYPE^F^^140;7^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,147,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.0201,147,21,0) ^.001^3^3^3101004^^^ "^DD",9002313.02,9002313.0201,147,21,1,0) This is used to store NCPDP field 147-U7 (Pharmacy Service Type), "^DD",9002313.02,9002313.0201,147,21,2,0) which is defined as "The type of service being performed by a pharmacy when different contractual terms exist between a payer and the pharmacy, "^DD",9002313.02,9002313.0201,147,21,3,0) or when benefits are based upon the type of service performed." "^DD",9002313.02,9002313.0201,147,23,0) ^.001^1^1^3101004^^ "^DD",9002313.02,9002313.0201,147,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,147,"DT") 3100831 "^DD",9002313.02,9002313.0201,308,0) OTHER COVERAGE CODE^F^^300;8^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,308,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,308,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.0201,308,21,1,0) Code indicating whether or not the patient has other insurance coverage. "^DD",9002313.02,9002313.0201,308,21,2,0) NCPDP standard field 308-C8. "^DD",9002313.02,9002313.0201,308,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.0201,308,23,1,0) REQUEST CLAIM SEGMENT "^DD",9002313.02,9002313.0201,308,"DT") 3080102 "^DD",9002313.02,9002313.0201,315,0) EMPLOYER NAME^F^^310;5^K:$L(X)>32!($L(X)<32) X "^DD",9002313.02,9002313.0201,315,3) Answer must be 32 characters in length "^DD",9002313.02,9002313.0201,315,21,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.0201,315,21,1,0) Complete name of employer. NCPDP standard field 315-CF. "^DD",9002313.02,9002313.0201,315,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.0201,315,23,1,0) REQUEST WORKER'S COMPENSATION SEGMENT "^DD",9002313.02,9002313.0201,315,"DT") 3080102 "^DD",9002313.02,9002313.0201,316,0) EMPLOYER STREET ADDRESS^F^^310;6^K:$L(X)>32!($L(X)<32) X "^DD",9002313.02,9002313.0201,316,3) Answer must be 32 characters in length "^DD",9002313.02,9002313.0201,316,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.0201,316,21,1,0) The Street address of the insured's employer. NCPDP standard field "^DD",9002313.02,9002313.0201,316,21,2,0) 316-CG. "^DD",9002313.02,9002313.0201,316,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.0201,316,23,1,0) REQUEST WORKER S COMPENSATION SEGMENT "^DD",9002313.02,9002313.0201,316,"DT") 3080102 "^DD",9002313.02,9002313.0201,317,0) EMPLOYER CITY ADDRESS^F^^310;7^K:$L(X)>22!($L(X)<22) X "^DD",9002313.02,9002313.0201,317,3) Answer must be 22 characters in length "^DD",9002313.02,9002313.0201,317,21,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.0201,317,21,1,0) Free-form text for city name. NCPDP standard field 317-CH. "^DD",9002313.02,9002313.0201,317,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.0201,317,23,1,0) REQUEST WORKER'S COMPENSATION SEGMENT "^DD",9002313.02,9002313.0201,317,"DT") 3080102 "^DD",9002313.02,9002313.0201,318,0) EMPLOYER STATE/PROV ADDRESS^F^^310;8^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,318,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,318,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.0201,318,21,1,0) Standard State/Province Code as defined by appropriate government "^DD",9002313.02,9002313.0201,318,21,2,0) agency. NCPDP standard field 318-CI. "^DD",9002313.02,9002313.0201,318,23,0) ^^3^3^3080102^ "^DD",9002313.02,9002313.0201,318,23,1,0) Standard United States and Canadian province two-letter postal service "^DD",9002313.02,9002313.0201,318,23,2,0) abbreviations should be used. "^DD",9002313.02,9002313.0201,318,23,3,0) REQUEST WORKER'S COMPENSATION SEGMENT "^DD",9002313.02,9002313.0201,318,"DT") 3210329 "^DD",9002313.02,9002313.0201,319,0) EMPLOYER ZIP/POSTAL ZONE^F^^310;9^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0201,319,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.0201,319,21,0) ^^2^2^3080102^ "^DD",9002313.02,9002313.0201,319,21,1,0) Code defining international postal zone excluding punctuation and blanks "^DD",9002313.02,9002313.0201,319,21,2,0) (zip code for US). NCPDP standard field 319-CJ. "^DD",9002313.02,9002313.0201,319,23,0) ^^9^9^3080102^ "^DD",9002313.02,9002313.0201,319,23,1,0) This left-justified field contains the five-digit zip code and may "^DD",9002313.02,9002313.0201,319,23,2,0) include the four-digit expanded zip code in which the employer is located. "^DD",9002313.02,9002313.0201,319,23,3,0) "^DD",9002313.02,9002313.0201,319,23,4,0) Examples: If the zip code is 98765-4321, this field would reflect: "^DD",9002313.02,9002313.0201,319,23,5,0) 987654321. "^DD",9002313.02,9002313.0201,319,23,6,0) "^DD",9002313.02,9002313.0201,319,23,7,0) If the zip code is 98765, this field would reflect: 98765 left justified. "^DD",9002313.02,9002313.0201,319,23,8,0) "^DD",9002313.02,9002313.0201,319,23,9,0) REQUEST WORKER S COMPENSATION SEGMENT "^DD",9002313.02,9002313.0201,319,"DT") 3210329 "^DD",9002313.02,9002313.0201,320,0) EMPLOYER TELEPHONE NUMBER^F^^310;10^K:$L(X)>12!($L(X)<12) X "^DD",9002313.02,9002313.0201,320,3) Answer must be 12 characters in length "^DD",9002313.02,9002313.0201,320,21,0) ^.001^1^1^3141231^^ "^DD",9002313.02,9002313.0201,320,21,1,0) Ten digit phone number of employer. NCPDP standard field 320-CK. "^DD",9002313.02,9002313.0201,320,23,0) ^.001^9^9^3141231^^ "^DD",9002313.02,9002313.0201,320,23,1,0) Format=AAAEEENNNN "^DD",9002313.02,9002313.0201,320,23,2,0) "^DD",9002313.02,9002313.0201,320,23,3,0) AAA=Area Code "^DD",9002313.02,9002313.0201,320,23,4,0) EEE=Exchange Code "^DD",9002313.02,9002313.0201,320,23,5,0) NNNN=Number "^DD",9002313.02,9002313.0201,320,23,6,0) "^DD",9002313.02,9002313.0201,320,23,7,0) Examples: A phone number of 212-555-1212 would reflect: 2125551212. "^DD",9002313.02,9002313.0201,320,23,8,0) "^DD",9002313.02,9002313.0201,320,23,9,0) REQUEST WORKER'S COMPENSATION SEGMENT "^DD",9002313.02,9002313.0201,320,"DT") 3141231 "^DD",9002313.02,9002313.0201,321,0) EMPLOYER CONTACT NAME^F^^320;1^K:$L(X)>32!($L(X)<32) X "^DD",9002313.02,9002313.0201,321,3) Answer must be 32 characters in length "^DD",9002313.02,9002313.0201,321,21,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.0201,321,21,1,0) Employer primary contact. NCPDP standard field 321-CL. "^DD",9002313.02,9002313.0201,321,23,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.0201,321,23,1,0) REQUEST WORKER'S COMPENSATION SEGMENT "^DD",9002313.02,9002313.0201,321,"DT") 3080102 "^DD",9002313.02,9002313.0201,327,0) CARRIER ID^F^^320;7^K:$L(X)>12!($L(X)<12) X "^DD",9002313.02,9002313.0201,327,3) Answer must be 12 characters in length "^DD",9002313.02,9002313.0201,327,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,327,21,1,0) Carrier code assigned in Worker's Compensation Program. NCPDP standard "^DD",9002313.02,9002313.0201,327,21,2,0) field 327-CR. "^DD",9002313.02,9002313.0201,327,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,327,23,1,0) REQUEST WORKER'S COMPENSATION SEGMENT "^DD",9002313.02,9002313.0201,327,"DT") 3080103 "^DD",9002313.02,9002313.0201,330,0) ALTERNATE ID^F^^320;10^K:$L(X)>22!($L(X)<22) X "^DD",9002313.02,9002313.0201,330,3) Answer must be 22 characters in length "^DD",9002313.02,9002313.0201,330,21,0) ^^3^3^3080103^ "^DD",9002313.02,9002313.0201,330,21,1,0) Person identifier to be used for controlled product reporting. Identifier "^DD",9002313.02,9002313.0201,330,21,2,0) may be that of the patient or the person picking up the prescription as "^DD",9002313.02,9002313.0201,330,21,3,0) required by the governing body. NCPDP standard field 330-CW. "^DD",9002313.02,9002313.0201,330,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,330,23,1,0) REQUEST CLAIM SEGMENT "^DD",9002313.02,9002313.0201,330,"DT") 3080103 "^DD",9002313.02,9002313.0201,337,0) COB/OTHER PAYMENTS COUNT^F^^330;7^K:$L(X)>1!($L(X)<1) X "^DD",9002313.02,9002313.0201,337,3) Answer must be 1 character in length. "^DD",9002313.02,9002313.0201,337,21,0) ^.001^1^1^3101004^^ "^DD",9002313.02,9002313.0201,337,21,1,0) Count of other payment occurrences. "^DD",9002313.02,9002313.0201,337,"DT") 3210329 "^DD",9002313.02,9002313.0201,337.01,0) COB OTHER PAYMENTS^9002313.0401A^^337;0 "^DD",9002313.02,9002313.0201,337.01,21,0) ^^1^1^3080604^ "^DD",9002313.02,9002313.0201,337.01,21,1,0) Multiple counter to store other coordination of benefit payments. "^DD",9002313.02,9002313.0201,337.01,"DT") 3080102 "^DD",9002313.02,9002313.0201,343,0) DISPENSING STATUS^F^^340;3^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.0201,343,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.0201,343,21,0) ^^4^4^3080103^ "^DD",9002313.02,9002313.0201,343,21,1,0) Code indicating the quantity dispensed is a partial fill or the "^DD",9002313.02,9002313.0201,343,21,2,0) completion of a partial fill. Used only in situations where inventory "^DD",9002313.02,9002313.0201,343,21,3,0) shortages do not allow the full quantity to be dispensed. NCPDP standard "^DD",9002313.02,9002313.0201,343,21,4,0) field 343-HD. "^DD",9002313.02,9002313.0201,343,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,343,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,343,"DT") 3080103 "^DD",9002313.02,9002313.0201,344,0) QTY INTENDED TO BE DISPENSED^F^^340;4^K:$L(X)>12!($L(X)<12) X "^DD",9002313.02,9002313.0201,344,3) Answer must be 12 characters in length "^DD",9002313.02,9002313.0201,344,21,0) ^^3^3^3080103^ "^DD",9002313.02,9002313.0201,344,21,1,0) Metric decimal quantity of medication that would be dispensed on original "^DD",9002313.02,9002313.0201,344,21,2,0) filling if inventory were available. Used in association with a 'P' or "^DD",9002313.02,9002313.0201,344,21,3,0) 'C' in Dispensing Status (343-HD). NCPDP standard field 344-HF. "^DD",9002313.02,9002313.0201,344,23,0) ^^3^3^3080103^ "^DD",9002313.02,9002313.0201,344,23,1,0) Format=9999999.999 "^DD",9002313.02,9002313.0201,344,23,2,0) "^DD",9002313.02,9002313.0201,344,23,3,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,344,"DT") 3210329 "^DD",9002313.02,9002313.0201,345,0) DAYS SUPPLY INTEND TO BE DISP^F^^340;5^K:$L(X)>5!($L(X)<5) X "^DD",9002313.02,9002313.0201,345,3) Answer must be 5 characters in length "^DD",9002313.02,9002313.0201,345,21,0) ^^4^4^3080103^ "^DD",9002313.02,9002313.0201,345,21,1,0) Days supply for metric decimal quantity of medication that would be "^DD",9002313.02,9002313.0201,345,21,2,0) dispensed on original dispensing if inventory were available. Used in "^DD",9002313.02,9002313.0201,345,21,3,0) association with a 'P' or 'C' in Dispensing Status (343-HD). NCPDP "^DD",9002313.02,9002313.0201,345,21,4,0) standard field 345-HG. "^DD",9002313.02,9002313.0201,345,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,345,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,345,"DT") 3210329 "^DD",9002313.02,9002313.0201,354,0) SUBMISSION CLARIF CODE COUNT^F^^350;4^K:$L(X)>3!($L(X)<1) X "^DD",9002313.02,9002313.0201,354,.1) SUBMISSION CLARIFICATION CODE COUNT "^DD",9002313.02,9002313.0201,354,3) Answer must be 1-3 characters. "^DD",9002313.02,9002313.0201,354,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.0201,354,21,1,0) This is used to store NCPDP field 354-NX (Submission Clarification Code Count), "^DD",9002313.02,9002313.0201,354,21,2,0) which is defined as "Count of the Submission Clarification Code (420-DK) occurrences." "^DD",9002313.02,9002313.0201,354,"DT") 3210329 "^DD",9002313.02,9002313.0201,354.01,0) SUBMISSION CLARIFICATION MLTPL^9002313.02354^^354.01;0 "^DD",9002313.02,9002313.0201,354.01,21,0) ^.001^1^1^3101020^^ "^DD",9002313.02,9002313.0201,354.01,21,1,0) This sub-file stores Submission Clarification values. "^DD",9002313.02,9002313.0201,354.01,"DT") 3100727 "^DD",9002313.02,9002313.0201,357,0) DELAY REASON CODE^F^^350;7^K:$L(X)>2!($L(X)<1) X "^DD",9002313.02,9002313.0201,357,3) Answer must be 1-2 characters. "^DD",9002313.02,9002313.0201,357,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.0201,357,21,1,0) This is used to store NCPDP field 357-NV (Delay Reason Code), "^DD",9002313.02,9002313.0201,357,21,2,0) which is defined as "Code to specify the reason that submission of the transactions has been delayed." "^DD",9002313.02,9002313.0201,357,"DT") 3100727 "^DD",9002313.02,9002313.0201,364,0) PRESCRIBER FIRST NAME^F^^360;4^K:$L(X)>14!($L(X)<1) X "^DD",9002313.02,9002313.0201,364,3) Answer must be 1-14 characters. "^DD",9002313.02,9002313.0201,364,21,0) ^.001^1^1^3101004^^^^ "^DD",9002313.02,9002313.0201,364,21,1,0) This is used to store NCPDP field 364-2J (Prescriber First Name). "^DD",9002313.02,9002313.0201,364,"DT") 3100727 "^DD",9002313.02,9002313.0201,365,0) PRESCRIBER STREET ADDRESS^F^^360;5^K:$L(X)>32!($L(X)<1) X "^DD",9002313.02,9002313.0201,365,3) Answer must be 1-32 characters. "^DD",9002313.02,9002313.0201,365,21,0) ^.001^2^2^3100929^^ "^DD",9002313.02,9002313.0201,365,21,1,0) This is used to store NCPDP field 365-2K (Prescriber Street Address), "^DD",9002313.02,9002313.0201,365,21,2,0) which is defined as "Free form text for prescriber address information." "^DD",9002313.02,9002313.0201,365,"DT") 3100727 "^DD",9002313.02,9002313.0201,366,0) PRESCRIBER CITY ADDRESS^F^^360;6^K:$L(X)>22!($L(X)<1) X "^DD",9002313.02,9002313.0201,366,3) Answer must be 1-22 characters. "^DD",9002313.02,9002313.0201,366,21,0) ^.001^2^2^3100929^^^ "^DD",9002313.02,9002313.0201,366,21,1,0) This is used to store NCPDP field 366-2M (Prescriber City Address), "^DD",9002313.02,9002313.0201,366,21,2,0) which is defined as "Free form text for prescriber city name." "^DD",9002313.02,9002313.0201,366,"DT") 3100727 "^DD",9002313.02,9002313.0201,367,0) PRESCRIBER STATE/PROV ADDRESS^F^^360;7^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,367,.1) PRESCRIBER STATE/PROVINCE ADDRESS "^DD",9002313.02,9002313.0201,367,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.0201,367,21,0) ^.001^2^2^3100929^^^ "^DD",9002313.02,9002313.0201,367,21,1,0) This is used to store NCPDP field 367-2N (Prescriber State/Province Address), "^DD",9002313.02,9002313.0201,367,21,2,0) which is defined as "Standard state /province code as defined by appropriate government agency." "^DD",9002313.02,9002313.0201,367,"DT") 3100825 "^DD",9002313.02,9002313.0201,368,0) PRESCRIBER ZIP/POSTAL ZONE^F^^360;8^K:$L(X)>11!($L(X)<1) X "^DD",9002313.02,9002313.0201,368,3) Answer must be 1-11 characters. "^DD",9002313.02,9002313.0201,368,21,0) ^.001^2^2^3100929^^ "^DD",9002313.02,9002313.0201,368,21,1,0) This is used to store NCPDP field 368-2P (Prescriber Zip/Postal Zone), "^DD",9002313.02,9002313.0201,368,21,2,0) which is defined as "Code defining international postal zone excluding punctuation and blanks." "^DD",9002313.02,9002313.0201,368,"DT") 3100727 "^DD",9002313.02,9002313.0201,369,0) ADDITIONAL DCMNTN TYPE ID^F^^360;9^K:$L(X)>5!($L(X)<1) X "^DD",9002313.02,9002313.0201,369,.1) ADDITIONAL DOCUMENTATION TYPE ID "^DD",9002313.02,9002313.0201,369,3) Answer must be 1-5 characters. "^DD",9002313.02,9002313.0201,369,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.0201,369,21,1,0) This is used to store NCPDP field 369-2Q (Additional Documentation Type ID), "^DD",9002313.02,9002313.0201,369,21,2,0) which is defined as "Unique identifier for the data being submitted." "^DD",9002313.02,9002313.0201,369,23,0) ^.001^1^1^3101004^^^ "^DD",9002313.02,9002313.0201,369,23,1,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.0201,369,"DT") 3210329 "^DD",9002313.02,9002313.0201,370,0) LENGTH OF NEED^F^^360;10^K:$L(X)>5!($L(X)<1) X "^DD",9002313.02,9002313.0201,370,3) Answer must be 1-5 characters. "^DD",9002313.02,9002313.0201,370,21,0) ^.001^3^3^3101004^^^^ "^DD",9002313.02,9002313.0201,370,21,1,0) This is used to store NCPDP field 370-2R (Length of Need), "^DD",9002313.02,9002313.0201,370,21,2,0) which is defined as "Length of time the physician expects the patient to require use of the ordered item. "^DD",9002313.02,9002313.0201,370,21,3,0) Qualified by Length of Need Qualifier (371-2S)." "^DD",9002313.02,9002313.0201,370,23,0) ^.001^1^1^3101004^^^ "^DD",9002313.02,9002313.0201,370,23,1,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.0201,370,"DT") 3100902 "^DD",9002313.02,9002313.0201,371,0) LENGTH OF NEED QUALIFIER^F^^370;1^K:$L(X)>5!($L(X)<1) X "^DD",9002313.02,9002313.0201,371,3) Answer must be 1-5 characters. "^DD",9002313.02,9002313.0201,371,21,0) ^.001^2^2^3101004^^^ "^DD",9002313.02,9002313.0201,371,21,1,0) This is used to store NCPDP field 371-2S (Length of Need Qualifier), "^DD",9002313.02,9002313.0201,371,21,2,0) which is defined as "Code qualifying the length of need." "^DD",9002313.02,9002313.0201,371,23,0) ^.001^3^3^3101004^^ "^DD",9002313.02,9002313.0201,371,23,1,0) Qualifies Length of Need (370-2R). "^DD",9002313.02,9002313.0201,371,23,2,0) Note: If value is 6, length of need would be 1. "^DD",9002313.02,9002313.0201,371,23,3,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.0201,371,"DT") 3100902 "^DD",9002313.02,9002313.0201,372,0) PRESCRIBER/SUPPLIER DT SIGNED^F^^370;2^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.0201,372,.1) PRESCRIBER/SUPPLIER DATE SIGNED "^DD",9002313.02,9002313.0201,372,3) Answer must be 1-10 characters in length. "^DD",9002313.02,9002313.0201,372,21,0) ^.001^2^2^3101004^^^ "^DD",9002313.02,9002313.0201,372,21,1,0) This is used to store NCPDP field 372-2T (Prescriber/Supplier Date Signed), "^DD",9002313.02,9002313.0201,372,21,2,0) which is defined as "The date the form was completed and signed by the ordering physician." "^DD",9002313.02,9002313.0201,372,23,0) ^.001^2^2^3101004^^ "^DD",9002313.02,9002313.0201,372,23,1,0) Format = CCYYMMDD "^DD",9002313.02,9002313.0201,372,23,2,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.0201,372,"DT") 3101025 "^DD",9002313.02,9002313.0201,373,0) REQUEST STATUS^F^^370;3^K:$L(X)>3!($L(X)<1) X "^DD",9002313.02,9002313.0201,373,3) Answer must be 1-3 characters. "^DD",9002313.02,9002313.0201,373,21,0) ^.001^2^2^3101004^^^ "^DD",9002313.02,9002313.0201,373,21,1,0) This is used to store NCPDP field 373-2U (Request Status), "^DD",9002313.02,9002313.0201,373,21,2,0) which is defined as "Code identifying type of request." "^DD",9002313.02,9002313.0201,373,23,0) ^.001^1^1^3101004^^ "^DD",9002313.02,9002313.0201,373,23,1,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.0201,373,"DT") 3100902 "^DD",9002313.02,9002313.0201,374,0) REQUEST PERIOD BEGIN DATE^F^^370;4^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.0201,374,3) Answer must be 1-10 characters. "^DD",9002313.02,9002313.0201,374,21,0) ^.001^2^2^3101004^^^ "^DD",9002313.02,9002313.0201,374,21,1,0) This is used to store NCPDP field 374-2V (Request Period Begin Date), "^DD",9002313.02,9002313.0201,374,21,2,0) which is defined as "The beginning date of need." "^DD",9002313.02,9002313.0201,374,23,0) ^.001^2^2^3101004^^ "^DD",9002313.02,9002313.0201,374,23,1,0) Format = CCYYMMDD "^DD",9002313.02,9002313.0201,374,23,2,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.0201,374,"DT") 3100902 "^DD",9002313.02,9002313.0201,375,0) REQ PERIOD RECERT/REVISED DT^F^^370;5^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.0201,375,.1) REQUEST PERIOD RECERT/REVISED DATE "^DD",9002313.02,9002313.0201,375,3) Answer must be 1-10 characters. "^DD",9002313.02,9002313.0201,375,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.0201,375,21,1,0) This is used to store NCPDP field 375-2W (Request Period Recert/Revised Date), "^DD",9002313.02,9002313.0201,375,21,2,0) which is defined as "The effective date of the revision or re-certification provided by the certifying physician." "^DD",9002313.02,9002313.0201,375,23,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.0201,375,23,1,0) Format = CCYYMMDD "^DD",9002313.02,9002313.0201,375,23,2,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.0201,375,"DT") 3210329 "^DD",9002313.02,9002313.0201,376,0) SUPPORTING DOCUMENTATION^F^^370;6^K:$L(X)>67!($L(X)<1) X "^DD",9002313.02,9002313.0201,376,3) Answer must be 1-67 characters. "^DD",9002313.02,9002313.0201,376,21,0) ^.001^2^2^3101004^^^ "^DD",9002313.02,9002313.0201,376,21,1,0) This is used to store NCPDP field 376-2X (Supporting Documentation), "^DD",9002313.02,9002313.0201,376,21,2,0) which is defined as "Free text message." "^DD",9002313.02,9002313.0201,376,23,0) ^.001^1^1^3101004^^ "^DD",9002313.02,9002313.0201,376,23,1,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.0201,376,"DT") 3100902 "^DD",9002313.02,9002313.0201,377,0) QUESTION NUMBER/LETTER COUNT^F^^370;7^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,377,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.0201,377,21,0) ^.001^2^2^3101005^^^ "^DD",9002313.02,9002313.0201,377,21,1,0) This is used to store NCPDP field 377-2Z (Question Number/Letter Count), "^DD",9002313.02,9002313.0201,377,21,2,0) which is defined as "Count of Question Number/Letter occurrences." "^DD",9002313.02,9002313.0201,377,23,0) ^.001^1^1^3101005^^ "^DD",9002313.02,9002313.0201,377,23,1,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.0201,377,"DT") 3100902 "^DD",9002313.02,9002313.0201,377.01,0) QUESTION NUMBER/LETTER MLTPL^9002313.023771^^377.01;0 "^DD",9002313.02,9002313.0201,377.01,21,0) ^.001^1^1^3101020^^ "^DD",9002313.02,9002313.0201,377.01,21,1,0) This sub-file stores Question Number/Letter values. "^DD",9002313.02,9002313.0201,385,0) FACILITY NAME^F^^380;5^K:$L(X)>32!($L(X)<1) X "^DD",9002313.02,9002313.0201,385,3) Answer must be 1-32 characters. "^DD",9002313.02,9002313.0201,385,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.0201,385,21,1,0) This is used to store NCPDP field 385-3Q (Facility Name), "^DD",9002313.02,9002313.0201,385,21,2,0) which is defined as "Name identifying the location of the service rendered." "^DD",9002313.02,9002313.0201,385,23,0) ^^2^2^3100901^ "^DD",9002313.02,9002313.0201,385,23,1,0) Note: This is not the name of the dispensing pharmacy. "^DD",9002313.02,9002313.0201,385,23,2,0) REQUEST FACILITY SEGMENT "^DD",9002313.02,9002313.0201,385,"DT") 3100901 "^DD",9002313.02,9002313.0201,386,0) FACILITY STREET ADDRESS^F^^380;6^K:$L(X)>32!($L(X)<1) X "^DD",9002313.02,9002313.0201,386,3) Answer must be 1-32 characters. "^DD",9002313.02,9002313.0201,386,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.0201,386,21,1,0) This is used to store NCPDP field 386-3U (Facility Street Address), "^DD",9002313.02,9002313.0201,386,21,2,0) which is defined as "Free form text for Facility address information." "^DD",9002313.02,9002313.0201,386,23,0) ^^1^1^3100901^ "^DD",9002313.02,9002313.0201,386,23,1,0) REQUEST FACILITY SEGMENT "^DD",9002313.02,9002313.0201,386,"DT") 3100901 "^DD",9002313.02,9002313.0201,387,0) FACILITY STATE/PROV ADDRESS^F^^380;7^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,387,.1) FACILITY STATE/PROVINCE ADDRESS "^DD",9002313.02,9002313.0201,387,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.0201,387,21,0) ^.001^2^2^3101014^^^ "^DD",9002313.02,9002313.0201,387,21,1,0) This is used to store NCPDP field 387-3V (Facility State/Province Address), "^DD",9002313.02,9002313.0201,387,21,2,0) which is defined as "Standard state /province code as defined by appropriate government agency." "^DD",9002313.02,9002313.0201,387,23,0) ^.001^1^1^3101014^^ "^DD",9002313.02,9002313.0201,387,23,1,0) REQUEST FACILITY SEGMENT. "^DD",9002313.02,9002313.0201,387,"DT") 3100901 "^DD",9002313.02,9002313.0201,388,0) FACILITY CITY ADDRESS^F^^380;8^K:$L(X)>22!($L(X)<1) X "^DD",9002313.02,9002313.0201,388,3) Answer must be 1-22 characters. "^DD",9002313.02,9002313.0201,388,21,0) ^.001^2^2^3101014^^^ "^DD",9002313.02,9002313.0201,388,21,1,0) This is used to store NCPDP field 388-5J (Facility City Address), "^DD",9002313.02,9002313.0201,388,21,2,0) which is defined as "Free form text for facility city name." "^DD",9002313.02,9002313.0201,388,23,0) ^.001^1^1^3101014^^ "^DD",9002313.02,9002313.0201,388,23,1,0) REQUEST FACILITY SEGMENT. "^DD",9002313.02,9002313.0201,388,"DT") 3100901 "^DD",9002313.02,9002313.0201,389,0) FACILITY ZIP/POSTAL ZONE^F^^380;9^K:$L(X)>18!($L(X)<1) X "^DD",9002313.02,9002313.0201,389,3) Answer must be 1-18 characters. "^DD",9002313.02,9002313.0201,389,21,0) ^.001^2^2^3101014^^^ "^DD",9002313.02,9002313.0201,389,21,1,0) This is used to store NCPDP field 389-6D (Facility Zip/Postal Zone), "^DD",9002313.02,9002313.0201,389,21,2,0) which is defined as "Code defining international postal zone excluding punctuation and blanks." "^DD",9002313.02,9002313.0201,389,23,0) ^.001^1^1^3101014^^ "^DD",9002313.02,9002313.0201,389,23,1,0) REQUEST FACILITY SEGMENT. "^DD",9002313.02,9002313.0201,389,"DT") 3100901 "^DD",9002313.02,9002313.0201,390,0) NARRATIVE MESSAGE^F^^389;2^K:$L(X)>202!($L(X)<1) X "^DD",9002313.02,9002313.0201,390,3) Answer must be 1-202 characters. "^DD",9002313.02,9002313.0201,390,21,0) ^.001^2^2^3101004^^^ "^DD",9002313.02,9002313.0201,390,21,1,0) This is used to store NCPDP field 390-BM (Narrative Message), "^DD",9002313.02,9002313.0201,390,21,2,0) which is defined as "Free form text." "^DD",9002313.02,9002313.0201,390,23,0) ^.001^2^2^3101004^^ "^DD",9002313.02,9002313.0201,390,23,1,0) REQUEST NARRATIVE SEGMENT. "^DD",9002313.02,9002313.0201,390,23,2,0) This field is the 2nd piece of node 389 because of its length. "^DD",9002313.02,9002313.0201,390,"DT") 3100902 "^DD",9002313.02,9002313.0201,391,0) PATIENT ASSIGNMENT INDICATOR^F^^390;1^K:$L(X)>3!($L(X)<1) X "^DD",9002313.02,9002313.0201,391,3) Answer must be 1-3 characters. "^DD",9002313.02,9002313.0201,391,21,0) ^.001^2^2^3100929^^^^ "^DD",9002313.02,9002313.0201,391,21,1,0) This is used to store NCPDP field 391-MT (Patient Assignment Indicator (Direct Member Reimbursement Indicator)), "^DD",9002313.02,9002313.0201,391,21,2,0) which is defined as "Code to indicate a patient's choice on assignment of benefits." "^DD",9002313.02,9002313.0201,391,"DT") 3100727 "^DD",9002313.02,9002313.0201,402,0) PRESCRIPTION/SERVICE REF NO^F^^400;2^K:$L(X)>14!($L(X)<1) X "^DD",9002313.02,9002313.0201,402,.1) PRESCRIPTION/SERVICE REFERENCE NUMBER "^DD",9002313.02,9002313.0201,402,3) Answer must be 1-14 characters. "^DD",9002313.02,9002313.0201,402,21,0) ^.001^2^2^3101020^^^^ "^DD",9002313.02,9002313.0201,402,21,1,0) This is the reference number assigned by the provider for the dispensed drug/product and/or service provided. "^DD",9002313.02,9002313.0201,402,21,2,0) It is NCPDP field 402-D2. The VA uses the Prescription IEN for this field. "^DD",9002313.02,9002313.0201,402,23,0) ^.001^3^3^3101020^^^^ "^DD",9002313.02,9002313.0201,402,23,1,0) Qualified by Prescription/Service Reference Number Qualifier (455-EM). "^DD",9002313.02,9002313.0201,402,23,2,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,402,23,3,0) RESPONSE CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,402,"DT") 3100929 "^DD",9002313.02,9002313.0201,403,0) FILL NUMBER^F^^400;3^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,403,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,403,21,0) ^^3^3^3080103^ "^DD",9002313.02,9002313.0201,403,21,1,0) The fill/refill number, starting at 0 for the original fill. The code "^DD",9002313.02,9002313.0201,403,21,2,0) indicating whether the prescription is an original or a refill. NCPDP "^DD",9002313.02,9002313.0201,403,21,3,0) standard field 403-D3. "^DD",9002313.02,9002313.0201,403,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,403,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,403,"DT") 3080103 "^DD",9002313.02,9002313.0201,405,0) DAYS SUPPLY^F^^400;5^K:$L(X)>5!($L(X)<5) X "^DD",9002313.02,9002313.0201,405,3) Answer must be 5 characters in length "^DD",9002313.02,9002313.0201,405,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,405,21,1,0) Estimated number of days the prescription will last. NCPDP standard "^DD",9002313.02,9002313.0201,405,21,2,0) field 405-D5. "^DD",9002313.02,9002313.0201,405,23,0) ^^4^4^3080103^ "^DD",9002313.02,9002313.0201,405,23,1,0) Examples: The prescription is estimated to last 30 days. This field would "^DD",9002313.02,9002313.0201,405,23,2,0) reflect: 30. "^DD",9002313.02,9002313.0201,405,23,3,0) "^DD",9002313.02,9002313.0201,405,23,4,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,405,"DT") 3080103 "^DD",9002313.02,9002313.0201,406,0) COMPOUND CODE^F^^400;6^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.0201,406,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.0201,406,21,0) ^.001^2^2^3101001^^ "^DD",9002313.02,9002313.0201,406,21,1,0) Field indicating whether this prescription was a compound (1) or not a "^DD",9002313.02,9002313.0201,406,21,2,0) compound (0). "^DD",9002313.02,9002313.0201,406,23,0) ^.001^1^1^3101001^^ "^DD",9002313.02,9002313.0201,406,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,406,"DT") 3080103 "^DD",9002313.02,9002313.0201,407,0) PRODUCT/SERVICE ID^F^^400;7^K:$L(X)>21!($L(X)<21) X "^DD",9002313.02,9002313.0201,407,3) Answer must be 21 characters in length "^DD",9002313.02,9002313.0201,407,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,407,21,1,0) ID of the product dispensed or service provided. NDC code in our case. "^DD",9002313.02,9002313.0201,407,21,2,0) NCPDP standard field 407-D7. "^DD",9002313.02,9002313.0201,407,23,0) ^^10^10^3080103^ "^DD",9002313.02,9002313.0201,407,23,1,0) Format=MMMMMDDDDPP "^DD",9002313.02,9002313.0201,407,23,2,0) "^DD",9002313.02,9002313.0201,407,23,3,0) MMMMM=Manufacturer's Assigned Number "^DD",9002313.02,9002313.0201,407,23,4,0) DDDD=Drug ID "^DD",9002313.02,9002313.0201,407,23,5,0) PP=Package Size "^DD",9002313.02,9002313.0201,407,23,6,0) "^DD",9002313.02,9002313.0201,407,23,7,0) Comments: Qualified by Product/Service ID Qualifier (436-E1) If "^DD",9002313.02,9002313.0201,407,23,8,0) Product Service ID Qualifier (436-E1) is 03=NDC "^DD",9002313.02,9002313.0201,407,23,9,0) "^DD",9002313.02,9002313.0201,407,23,10,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,407,"DT") 3210329 "^DD",9002313.02,9002313.0201,408,0) DAW PRODUCT SELECTION CODE^F^^400;8^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.0201,408,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.0201,408,21,0) ^^2^2^3080604^ "^DD",9002313.02,9002313.0201,408,21,1,0) Code indicating whether or not the prescriber's instructions regarding "^DD",9002313.02,9002313.0201,408,21,2,0) generic substitution were followed. NCPDP standard field 408-D8. "^DD",9002313.02,9002313.0201,408,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,408,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,408,"DT") 3210329 "^DD",9002313.02,9002313.0201,409,0) INGREDIENT COST SUBMITTED^F^^400;9^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,409,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,409,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,409,21,1,0) Submitted product component cost of the dispensed prescription. This "^DD",9002313.02,9002313.0201,409,21,2,0) amount is included in the 'Gross Amount Due' (430-DU). "^DD",9002313.02,9002313.0201,409,23,0) ^^9^9^3080103^ "^DD",9002313.02,9002313.0201,409,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.0201,409,23,2,0) "^DD",9002313.02,9002313.0201,409,23,3,0) Comments: This field can be further defined by using the Basis of Cost "^DD",9002313.02,9002313.0201,409,23,4,0) Determination Field 423-DN. "^DD",9002313.02,9002313.0201,409,23,5,0) "^DD",9002313.02,9002313.0201,409,23,6,0) Examples: If the ingredient cost submitted is $65.00, this field would "^DD",9002313.02,9002313.0201,409,23,7,0) reflect: 650{. "^DD",9002313.02,9002313.0201,409,23,8,0) "^DD",9002313.02,9002313.0201,409,23,9,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,409,"DT") 3080103 "^DD",9002313.02,9002313.0201,411,0) PRESCRIBER ID^F^^400;11^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0201,411,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.0201,411,21,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,411,21,1,0) ID assigned to the prescriber. "^DD",9002313.02,9002313.0201,411,23,0) ^^6^6^3080103^ "^DD",9002313.02,9002313.0201,411,23,1,0) Regarding the Telecommunication Standard: "^DD",9002313.02,9002313.0201,411,23,2,0) "^DD",9002313.02,9002313.0201,411,23,3,0) Comments: Qualified by Prescriber ID Qualifier (466-EZ) for the "^DD",9002313.02,9002313.0201,411,23,4,0) Telecommunications Standard. "^DD",9002313.02,9002313.0201,411,23,5,0) "^DD",9002313.02,9002313.0201,411,23,6,0) REQUEST PRESCRIBER SEGMENT "^DD",9002313.02,9002313.0201,411,"DT") 3080103 "^DD",9002313.02,9002313.0201,412,0) DISPENSING FEE SUBMITTED^F^^400;12^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,412,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,412,21,0) ^.001^2^2^3110805^^ "^DD",9002313.02,9002313.0201,412,21,1,0) Dispensing fee submitted by the pharmacy. This amount is included in the "^DD",9002313.02,9002313.0201,412,21,2,0) 'Gross Amount Due' (430-DU). NCPDP standard field 412-DC. "^DD",9002313.02,9002313.0201,412,23,0) ^.001^6^6^3110805^^^^ "^DD",9002313.02,9002313.0201,412,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.0201,412,23,2,0) "^DD",9002313.02,9002313.0201,412,23,3,0) Examples: If the pharmacy submitted a $5.62 dispensing fee, this field "^DD",9002313.02,9002313.0201,412,23,4,0) would reflect: 56B. "^DD",9002313.02,9002313.0201,412,23,5,0) "^DD",9002313.02,9002313.0201,412,23,6,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,412,"DT") 3080103 "^DD",9002313.02,9002313.0201,414,0) DATE PRESCRIPTION WRITTEN^F^^400;14^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,414,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,414,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,414,21,1,0) Date prescription was written. This will be the fill/refill date for "^DD",9002313.02,9002313.0201,414,21,2,0) local fills, the released date for CMOP. NCPDP standard field 414-DE. "^DD",9002313.02,9002313.0201,414,23,0) ^^11^11^3080103^ "^DD",9002313.02,9002313.0201,414,23,1,0) Format=CCYYMMDD "^DD",9002313.02,9002313.0201,414,23,2,0) "^DD",9002313.02,9002313.0201,414,23,3,0) CC=Century "^DD",9002313.02,9002313.0201,414,23,4,0) YY=Year "^DD",9002313.02,9002313.0201,414,23,5,0) MM=Month "^DD",9002313.02,9002313.0201,414,23,6,0) DD=Day "^DD",9002313.02,9002313.0201,414,23,7,0) "^DD",9002313.02,9002313.0201,414,23,8,0) Examples: For a prescription written on August 1, 1999, field would "^DD",9002313.02,9002313.0201,414,23,9,0) reflect: 19990801. "^DD",9002313.02,9002313.0201,414,23,10,0) "^DD",9002313.02,9002313.0201,414,23,11,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,414,"DT") 3080103 "^DD",9002313.02,9002313.0201,415,0) NUMBER OF REFILLS AUTHORIZED^F^^400;15^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,415,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,415,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,415,21,1,0) Number of refills authorized by the prescriber. The number of refills "^DD",9002313.02,9002313.0201,415,21,2,0) allowed that was entered during order entry. NCPDP standard field 415-DF. "^DD",9002313.02,9002313.0201,415,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,415,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,415,"DT") 3080103 "^DD",9002313.02,9002313.0201,418,0) LEVEL OF SERVICE^F^^400;18^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,418,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,418,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,418,21,1,0) Coding indicating the type of service the provider rendered. Not "^DD",9002313.02,9002313.0201,418,21,2,0) utilized, populated with DI00. NCPDP standard field 418-DI. "^DD",9002313.02,9002313.0201,418,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,418,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,418,"DT") 3080103 "^DD",9002313.02,9002313.0201,419,0) PRESCRIPTION ORIGIN CODE^F^^400;19^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.0201,419,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.0201,419,21,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,419,21,1,0) Code indicating the origin of the prescription. "^DD",9002313.02,9002313.0201,419,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,419,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,419,"DT") 3080103 "^DD",9002313.02,9002313.0201,421,0) PRIMARY CARE PROVIDER ID^F^^400;21^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0201,421,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.0201,421,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,421,21,1,0) ID assigned to the primary care provider. Used when the patient is "^DD",9002313.02,9002313.0201,421,21,2,0) referred to a secondary care provider. NCPDP standard field 421-DL. "^DD",9002313.02,9002313.0201,421,23,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,421,23,1,0) Qualified by Primary Care Provider ID Qualifier (468-2E). "^DD",9002313.02,9002313.0201,421,23,2,0) REQUEST PRESCRIBER SEGMENT. "^DD",9002313.02,9002313.0201,421,"DT") 3080103 "^DD",9002313.02,9002313.0201,423,0) BASIS OF COST DETERMINATION^F^^400;23^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,423,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,423,21,0) ^^3^3^3080103^ "^DD",9002313.02,9002313.0201,423,21,1,0) Code indicating the method by which 'Ingredient Cost Submitted' (Field "^DD",9002313.02,9002313.0201,423,21,2,0) 409-D9) was calculated. How the amount charged was determined. NCPDP "^DD",9002313.02,9002313.0201,423,21,3,0) standard field 423-DN. "^DD",9002313.02,9002313.0201,423,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,423,23,1,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,423,"DT") 3080103 "^DD",9002313.02,9002313.0201,424,0) DIAGNOSIS CODE^F^^400;24^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0201,424,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.0201,424,21,0) ^^3^3^3080103^ "^DD",9002313.02,9002313.0201,424,21,1,0) Code identifying the diagnosis of the patient. Not used for third party "^DD",9002313.02,9002313.0201,424,21,2,0) billing as of this date - so it is not used, but may be used in the "^DD",9002313.02,9002313.0201,424,21,3,0) future. NCPDP standard field 424-DO. "^DD",9002313.02,9002313.0201,424,23,0) ^^3^3^3080103^ "^DD",9002313.02,9002313.0201,424,23,1,0) Qualified by a Diagnosis Code Qualifier (492-WE). The format must "^DD",9002313.02,9002313.0201,424,23,2,0) adhere to the owner's code set rules and formats. "^DD",9002313.02,9002313.0201,424,23,3,0) REQUEST CLINICAL SEGMENT. "^DD",9002313.02,9002313.0201,424,"DT") 3080103 "^DD",9002313.02,9002313.0201,426,0) USUAL AND CUSTOMARY CHARGE^F^^400;26^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,426,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,426,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,426,21,1,0) Amount charged cash customers for the prescription exclusive of sales tax "^DD",9002313.02,9002313.0201,426,21,2,0) or other amounts claimed. NCPDP standard field 426-DQ. "^DD",9002313.02,9002313.0201,426,23,0) ^^6^6^3080103^ "^DD",9002313.02,9002313.0201,426,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.0201,426,23,2,0) "^DD",9002313.02,9002313.0201,426,23,3,0) Examples: If the usual and customary charge is $32.56, this field would "^DD",9002313.02,9002313.0201,426,23,4,0) reflect: 325F. "^DD",9002313.02,9002313.0201,426,23,5,0) "^DD",9002313.02,9002313.0201,426,23,6,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,426,"DT") 3080103 "^DD",9002313.02,9002313.0201,427,0) PRESCRIBER LAST NAME^F^^420;27^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0201,427,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.0201,427,21,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,427,21,1,0) Last Name of the Prescriber. NCPDP standard field 427-DR. "^DD",9002313.02,9002313.0201,427,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,427,23,1,0) REQUEST PRESCRIBER SEGMENT. "^DD",9002313.02,9002313.0201,427,"DT") 3080103 "^DD",9002313.02,9002313.0201,429,0) SPECIAL PACKAGING INDICATOR^F^^400;29^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.0201,429,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.0201,429,21,0) ^^7^7^3080103^ "^DD",9002313.02,9002313.0201,429,21,1,0) Code indicating the type of Unit Dose dispensing. NCPDP standard field "^DD",9002313.02,9002313.0201,429,21,2,0) 429-DT. "^DD",9002313.02,9002313.0201,429,21,3,0) "^DD",9002313.02,9002313.0201,429,21,4,0) 0=Not Specified "^DD",9002313.02,9002313.0201,429,21,5,0) 1=Not Unit Dose "^DD",9002313.02,9002313.0201,429,21,6,0) 2=Manufacturer Unit Dose "^DD",9002313.02,9002313.0201,429,21,7,0) 3=Pharmacy Unit Dose "^DD",9002313.02,9002313.0201,429,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,429,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,429,"DT") 3080103 "^DD",9002313.02,9002313.0201,430,0) GROSS AMOUNT DUE^F^^400;30^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,430,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,430,21,0) ^^9^9^3080103^ "^DD",9002313.02,9002313.0201,430,21,1,0) Total price claimed from all sources. For prescription claim request, "^DD",9002313.02,9002313.0201,430,21,2,0) field represents a sum of Ingredient Cost Submitted (409-D9), Dispensing "^DD",9002313.02,9002313.0201,430,21,3,0) Fee Submitted (412-DC), Flat Sales Tax Amount Submitted (481-HA), "^DD",9002313.02,9002313.0201,430,21,4,0) Percentage Sales Tax Amount Submitted (482-GE), Incentive Amount "^DD",9002313.02,9002313.0201,430,21,5,0) Submitted (438-E3), Other Amount Claimed (480-H9). For service claim "^DD",9002313.02,9002313.0201,430,21,6,0) request, field represents a sum of Professional Services Fee Submitted "^DD",9002313.02,9002313.0201,430,21,7,0) (477-BE), Flat Sales Tax Amount Submitted (481-HA), Percentage Sales Tax "^DD",9002313.02,9002313.0201,430,21,8,0) Amount Submitted (482-GE), Other Amount Claimed (480-H9). NCPDP standard "^DD",9002313.02,9002313.0201,430,21,9,0) field 430-DU. "^DD",9002313.02,9002313.0201,430,23,0) ^^6^6^3080103^ "^DD",9002313.02,9002313.0201,430,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.0201,430,23,2,0) "^DD",9002313.02,9002313.0201,430,23,3,0) Examples: If the gross amount due is $14.95, this field would reflect: "^DD",9002313.02,9002313.0201,430,23,4,0) 149E. "^DD",9002313.02,9002313.0201,430,23,5,0) "^DD",9002313.02,9002313.0201,430,23,6,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,430,"DT") 3080103 "^DD",9002313.02,9002313.0201,431,0) OTHER PAYER AMOUNT PAID^F^^430;1^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,431,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,431,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,431,21,1,0) Amount of any payment known by the pharmacy from other sources. NCPDP "^DD",9002313.02,9002313.0201,431,21,2,0) standard field 431-DV. "^DD",9002313.02,9002313.0201,431,23,0) ^.001^6^6^3101020^^ "^DD",9002313.02,9002313.0201,431,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.0201,431,23,2,0) "^DD",9002313.02,9002313.0201,431,23,3,0) Examples: If the other payer amount paid is $32.56, this field would "^DD",9002313.02,9002313.0201,431,23,4,0) reflect: 325F. "^DD",9002313.02,9002313.0201,431,23,5,0) "^DD",9002313.02,9002313.0201,431,23,6,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.0201,431,"DT") 3210330 "^DD",9002313.02,9002313.0201,433,0) PATIENT PAID AMOUNT REPORTED^F^^430;3^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,433,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,433,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,433,21,1,0) Amount the pharmacy received from the patient for the prescription "^DD",9002313.02,9002313.0201,433,21,2,0) dispensed. "^DD",9002313.02,9002313.0201,433,23,0) ^^10^10^3080103^ "^DD",9002313.02,9002313.0201,433,23,1,0) This field is not used in coordination of benefit transactions to pass "^DD",9002313.02,9002313.0201,433,23,2,0) patent liability information to a downstream payer. See Other "^DD",9002313.02,9002313.0201,433,23,3,0) Payer-Patient Responsibility Amount (352-NQ). "^DD",9002313.02,9002313.0201,433,23,4,0) "^DD",9002313.02,9002313.0201,433,23,5,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.0201,433,23,6,0) "^DD",9002313.02,9002313.0201,433,23,7,0) Examples: If the patient paid amount submitted is $10.50, this field "^DD",9002313.02,9002313.0201,433,23,8,0) would reflect: 105{. "^DD",9002313.02,9002313.0201,433,23,9,0) "^DD",9002313.02,9002313.0201,433,23,10,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,433,"DT") 3210330 "^DD",9002313.02,9002313.0201,434,0) DATE OF INJURY^F^^430;4^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,434,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,434,21,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,434,21,1,0) Date on which the injury occurred. NCPDP standard field 434-DY. "^DD",9002313.02,9002313.0201,434,23,0) ^^11^11^3080103^ "^DD",9002313.02,9002313.0201,434,23,1,0) Format=CCYYMMDD "^DD",9002313.02,9002313.0201,434,23,2,0) "^DD",9002313.02,9002313.0201,434,23,3,0) CC=Century "^DD",9002313.02,9002313.0201,434,23,4,0) YY=Year "^DD",9002313.02,9002313.0201,434,23,5,0) MM=Month "^DD",9002313.02,9002313.0201,434,23,6,0) DD=Day "^DD",9002313.02,9002313.0201,434,23,7,0) "^DD",9002313.02,9002313.0201,434,23,8,0) Examples: If injury occurred on July 1, 1999, field would reflect: "^DD",9002313.02,9002313.0201,434,23,9,0) 19990701. "^DD",9002313.02,9002313.0201,434,23,10,0) "^DD",9002313.02,9002313.0201,434,23,11,0) REQUEST WORKER S COMPENSATION SEGMENT. "^DD",9002313.02,9002313.0201,434,"DT") 3080103 "^DD",9002313.02,9002313.0201,435,0) CLAIM/REFERENCE ID^F^^430;5^K:$L(X)>32!($L(X)<32) X "^DD",9002313.02,9002313.0201,435,3) Answer must be 32 characters in length "^DD",9002313.02,9002313.0201,435,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,435,21,1,0) Identifies the claim number assigned by Worker s Compensation Program. "^DD",9002313.02,9002313.0201,435,21,2,0) NCPDP standard field 435-DZ. "^DD",9002313.02,9002313.0201,435,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,435,23,1,0) REQUEST WORKER S COMPENSATION SEGMENT. "^DD",9002313.02,9002313.0201,435,"DT") 3210330 "^DD",9002313.02,9002313.0201,436,0) PRODUCT/SERVICE ID QUALIFIER^F^^430;6^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,436,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,436,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,436,21,1,0) Code qualifying the value in 'Product/Service ID' (407-D7). NCPDP "^DD",9002313.02,9002313.0201,436,21,2,0) standard field 436-E1. "^DD",9002313.02,9002313.0201,436,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,436,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,436,"DT") 3210330 "^DD",9002313.02,9002313.0201,438,0) INCENTIVE AMOUNT SUBMITTED^F^^430;8^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,438,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,438,21,0) ^^3^3^3080103^ "^DD",9002313.02,9002313.0201,438,21,1,0) Amount represents a fee that is submitted by the pharmacy for "^DD",9002313.02,9002313.0201,438,21,2,0) contractually agreed upon services. This amount is included in the 'Gross "^DD",9002313.02,9002313.0201,438,21,3,0) Amount Due' (430-DU). "^DD",9002313.02,9002313.0201,438,23,0) ^^6^6^3080103^ "^DD",9002313.02,9002313.0201,438,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.0201,438,23,2,0) "^DD",9002313.02,9002313.0201,438,23,3,0) Examples: If the incentive amount submitted is $4.50, this field would "^DD",9002313.02,9002313.0201,438,23,4,0) reflect: 45{. "^DD",9002313.02,9002313.0201,438,23,5,0) "^DD",9002313.02,9002313.0201,438,23,6,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,438,"DT") 3080103 "^DD",9002313.02,9002313.0201,442,0) QUANTITY DISPENSED^F^^440;2^K:$L(X)>12!($L(X)<12) X "^DD",9002313.02,9002313.0201,442,3) Answer must be 12 characters in length "^DD",9002313.02,9002313.0201,442,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,442,21,1,0) Quantity dispensed expressed in metric decimal units. NCPDP standard "^DD",9002313.02,9002313.0201,442,21,2,0) field 442-E7. "^DD",9002313.02,9002313.0201,442,23,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,442,23,1,0) Format=9999999.999 "^DD",9002313.02,9002313.0201,442,23,2,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,442,"DT") 3080103 "^DD",9002313.02,9002313.0201,443,0) OTHER PAYER DATE^F^^440;3^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,443,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,443,21,0) ^^2^2^3080604^ "^DD",9002313.02,9002313.0201,443,21,1,0) Payment or denial date of the claim submitted to the other payer. Used "^DD",9002313.02,9002313.0201,443,21,2,0) for coordination of benefits. NCPDP standard field 443-E8. "^DD",9002313.02,9002313.0201,443,23,0) ^^11^11^3080604^ "^DD",9002313.02,9002313.0201,443,23,1,0) Format=CCYYMMDD "^DD",9002313.02,9002313.0201,443,23,2,0) "^DD",9002313.02,9002313.0201,443,23,3,0) CC=Century "^DD",9002313.02,9002313.0201,443,23,4,0) YY=Year "^DD",9002313.02,9002313.0201,443,23,5,0) MM=Month "^DD",9002313.02,9002313.0201,443,23,6,0) DD=Day "^DD",9002313.02,9002313.0201,443,23,7,0) "^DD",9002313.02,9002313.0201,443,23,8,0) Examples: If the primary payer denial date was August 1,1999, this field "^DD",9002313.02,9002313.0201,443,23,9,0) would reflect: 19990801. "^DD",9002313.02,9002313.0201,443,23,10,0) "^DD",9002313.02,9002313.0201,443,23,11,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT "^DD",9002313.02,9002313.0201,443,"DT") 3080604 "^DD",9002313.02,9002313.0201,444,0) PROVIDER ID^F^^440;4^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0201,444,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.0201,444,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,444,21,1,0) Unique ID assigned to the person responsible for the dispensing of the "^DD",9002313.02,9002313.0201,444,21,2,0) prescription or provision of the service. "^DD",9002313.02,9002313.0201,444,23,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,444,23,1,0) Qualified by Provider ID Qualifier (465-EY). "^DD",9002313.02,9002313.0201,444,23,2,0) REQUEST PHARMACY PROVIDER SEGMENT. "^DD",9002313.02,9002313.0201,444,"DT") 3080103 "^DD",9002313.02,9002313.0201,445,0) ORIG PRESCRIBED PROD/SERV CODE^F^^440;5^K:$L(X)>21!($L(X)<21) X "^DD",9002313.02,9002313.0201,445,3) Answer must be 21 characters in length "^DD",9002313.02,9002313.0201,445,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,445,21,1,0) Code of the initially prescribed product or service. NCPDP standard "^DD",9002313.02,9002313.0201,445,21,2,0) field 445-EA. "^DD",9002313.02,9002313.0201,445,23,0) ^^3^3^3080103^ "^DD",9002313.02,9002313.0201,445,23,1,0) Qualified by Originally Prescribed Product/Service Code Qualifier "^DD",9002313.02,9002313.0201,445,23,2,0) (453-EJ). "^DD",9002313.02,9002313.0201,445,23,3,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,445,"DT") 3210330 "^DD",9002313.02,9002313.0201,446,0) ORIGINALLY PRESCRIBED QUANTITY^F^^440;6^K:$L(X)>12!($L(X)<12) X "^DD",9002313.02,9002313.0201,446,3) Answer must be 12 characters in length "^DD",9002313.02,9002313.0201,446,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,446,21,1,0) Product initially prescribed amount expressed in metric decimal units. "^DD",9002313.02,9002313.0201,446,21,2,0) NCPDP standard field 446-EB. "^DD",9002313.02,9002313.0201,446,23,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,446,23,1,0) Format=9999999.999 "^DD",9002313.02,9002313.0201,446,23,2,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,446,"DT") 3080103 "^DD",9002313.02,9002313.0201,447,0) COMPOUND INGREDIENT COMP COUNT^F^^440;7^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,447,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,447,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0201,447,21,1,0) Count of compound product IDs (both active and inactive) in the compound "^DD",9002313.02,9002313.0201,447,21,2,0) mixture submitted. NCPDP standard field 447-EC. "^DD",9002313.02,9002313.0201,447,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0201,447,23,1,0) REQUEST COMPOUND SEGMENT. "^DD",9002313.02,9002313.0201,447,"DT") 3210330 "^DD",9002313.02,9002313.0201,447.01,0) COMPOUND REPEATING FIELDS^9002313.0501A^^447;0 "^DD",9002313.02,9002313.0201,447.01,3) "^DD",9002313.02,9002313.0201,447.01,21,0) ^^1^1^3080604^ "^DD",9002313.02,9002313.0201,447.01,21,1,0) Multiple to store multiple compounds in a prescription. "^DD",9002313.02,9002313.0201,447.01,"DT") 3080102 "^DD",9002313.02,9002313.0201,450,0) COMPOUND DOSAGE FORM DESC CODE^F^^440;10^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0201,450,3) Answer must be 17 characters in length. "^DD",9002313.02,9002313.0201,450,21,0) ^^2^2^3130226^ "^DD",9002313.02,9002313.0201,450,21,1,0) Dosage form of the complete compound mixture. NCPDP standard field "^DD",9002313.02,9002313.0201,450,21,2,0) 450-EF. "^DD",9002313.02,9002313.0201,450,23,0) ^^1^1^3130226^ "^DD",9002313.02,9002313.0201,450,23,1,0) REQUEST COMPOUND SEGMENT. "^DD",9002313.02,9002313.0201,450,"DT") 3210330 "^DD",9002313.02,9002313.0201,451,0) COMPOUND DISP UNIT FORM INDCTR^F^^450;1^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.0201,451,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.0201,451,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,451,21,1,0) NCPDP standard product billing codes. NCPDP standard field 451-EG. "^DD",9002313.02,9002313.0201,451,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,451,23,1,0) REQUEST COMPOUND SEGMENT. "^DD",9002313.02,9002313.0201,451,"DT") 3210330 "^DD",9002313.02,9002313.0201,452,0) COMPOUND ROUTE OF ADMIN^F^^450;2^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,452,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,452,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,452,21,1,0) Code for the route of administration of the complete compound mixture. "^DD",9002313.02,9002313.0201,452,21,2,0) NCPDP standard field 452-EH. "^DD",9002313.02,9002313.0201,452,"DT") 3080104 "^DD",9002313.02,9002313.0201,453,0) ORIG PRESCR PROD/SERV ID QUAL^F^^450;3^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,453,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,453,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,453,21,1,0) Code qualifying the value in 'Originally Prescribed Product/Service Code' "^DD",9002313.02,9002313.0201,453,21,2,0) (Field 445-EA). NCPDP standard field 453-EJ. "^DD",9002313.02,9002313.0201,453,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,453,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,453,"DT") 3210330 "^DD",9002313.02,9002313.0201,454,0) SCHEDULED PRESCRIPTION ID NUM^F^^450;4^K:$L(X)>14!($L(X)<14) X "^DD",9002313.02,9002313.0201,454,3) Answer must be 14 characters in length "^DD",9002313.02,9002313.0201,454,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,454,21,1,0) The serial number of the prescription blank/form. NCPDP standard field "^DD",9002313.02,9002313.0201,454,21,2,0) 454-EK. "^DD",9002313.02,9002313.0201,454,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,454,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,454,"DT") 3210330 "^DD",9002313.02,9002313.0201,455,0) PRESCRIPTION/SERV REF NO QLFR^F^^450;5^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.0201,455,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.0201,455,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,455,21,1,0) Indicates the type of billing submitted. NCPDP standard field 455-EM. "^DD",9002313.02,9002313.0201,455,23,0) ^^3^3^3080104^ "^DD",9002313.02,9002313.0201,455,23,1,0) Qualifies Prescription/Service Reference Number (402-D2). "^DD",9002313.02,9002313.0201,455,23,2,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,455,23,3,0) RESPONSE CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,455,"DT") 3210330 "^DD",9002313.02,9002313.0201,456,0) ASSOC PRESCRIPTION/SERV REF NO^F^^450;6^K:$L(X)>14!($L(X)<14) X "^DD",9002313.02,9002313.0201,456,.1) ASSOCIATED PRESCRIPTION/SERVICE REFERENCE NUMBER "^DD",9002313.02,9002313.0201,456,3) Answer must be 14 characters in length. "^DD",9002313.02,9002313.0201,456,21,0) ^.001^2^2^3101020^^^^ "^DD",9002313.02,9002313.0201,456,21,1,0) This is the Related Prescription/Service Reference Number (402-D2) "^DD",9002313.02,9002313.0201,456,21,2,0) to which the service is associated. It is NCPDP field 456-EN. "^DD",9002313.02,9002313.0201,456,23,0) ^.001^1^1^3101020^^^^ "^DD",9002313.02,9002313.0201,456,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,456,"DT") 3210330 "^DD",9002313.02,9002313.0201,457,0) ASSOC PRESCRIPTION/SERV DATE^F^^450;7^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,457,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,457,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,457,21,1,0) Date of the Associated Prescription/Service Reference Number (456-EN). "^DD",9002313.02,9002313.0201,457,21,2,0) NCPDP standard field 457-EP. "^DD",9002313.02,9002313.0201,457,23,0) ^^8^8^3080104^ "^DD",9002313.02,9002313.0201,457,23,1,0) Format=CCYYMMDD "^DD",9002313.02,9002313.0201,457,23,2,0) "^DD",9002313.02,9002313.0201,457,23,3,0) CC=Century "^DD",9002313.02,9002313.0201,457,23,4,0) YY=Year "^DD",9002313.02,9002313.0201,457,23,5,0) MM=Month "^DD",9002313.02,9002313.0201,457,23,6,0) DD=Day "^DD",9002313.02,9002313.0201,457,23,7,0) "^DD",9002313.02,9002313.0201,457,23,8,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,457,"DT") 3210330 "^DD",9002313.02,9002313.0201,458,0) PROCEDURE MODIFIER CODE COUNT^F^^450;8^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,458,3) Answer must be 4 characters in length. "^DD",9002313.02,9002313.0201,458,21,0) ^.001^2^2^3101020^^^^ "^DD",9002313.02,9002313.0201,458,21,1,0) This is the count of the Procedure Modifier Code (459-ER) occurrences. "^DD",9002313.02,9002313.0201,458,21,2,0) It is NCPDP field 458-SE. "^DD",9002313.02,9002313.0201,458,23,0) ^.001^1^1^3101020^^^^ "^DD",9002313.02,9002313.0201,458,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,458,"DT") 3101004 "^DD",9002313.02,9002313.0201,459,0) PROCEDURE MODIFIER CODE^9002313.201459A^^459;0 "^DD",9002313.02,9002313.0201,459,21,0) ^^1^1^3031216^ "^DD",9002313.02,9002313.0201,459,21,1,0) Multiple for storing procedure code information. "^DD",9002313.02,9002313.0201,459,"DT") 3080102 "^DD",9002313.02,9002313.0201,460,0) QUANTITY PRESCRIBED^F^^450;10^K:$L(X)>12!($L(X)<12) X "^DD",9002313.02,9002313.0201,460,3) Answer must be 12 characters in length "^DD",9002313.02,9002313.0201,460,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,460,21,1,0) Amount expressed in metric decimal units. Quantity prescribed during "^DD",9002313.02,9002313.0201,460,21,2,0) order entry. NCPDP standard field 460-ET. "^DD",9002313.02,9002313.0201,460,23,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,460,23,1,0) Format=9999999.999 "^DD",9002313.02,9002313.0201,460,23,2,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,460,"DT") 3080104 "^DD",9002313.02,9002313.0201,461,0) PRIOR AUTHORIZATION TYPE CODE^F^^460;1^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,461,3) Answer must be 4 characters in length. "^DD",9002313.02,9002313.0201,461,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,461,21,1,0) Code clarifying the Prior Authorization Number Submitted (462-EV) or "^DD",9002313.02,9002313.0201,461,21,2,0) benefit/plan exemption. NCPDP standard field 461-EU. "^DD",9002313.02,9002313.0201,461,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,461,23,1,0) REQUEST CLAIM SEGMENT "^DD",9002313.02,9002313.0201,461,"DT") 3080104 "^DD",9002313.02,9002313.0201,462,0) PRIOR AUTH NUMBER SUBMITTED^F^^460;2^K:$L(X)>13!($L(X)<13) X "^DD",9002313.02,9002313.0201,462,3) Answer must be 13 characters in length. "^DD",9002313.02,9002313.0201,462,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,462,21,1,0) Number submitted by the provider to identify the prior authorization. "^DD",9002313.02,9002313.0201,462,21,2,0) NCPDP standard field 462-EV. "^DD",9002313.02,9002313.0201,462,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,462,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,462,"DT") 3210330 "^DD",9002313.02,9002313.0201,463,0) INTERMEDIARY AUTH TYPE ID^F^^460;3^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,463,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,463,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,463,21,1,0) Value indicating that authorization occurred for intermediary "^DD",9002313.02,9002313.0201,463,21,2,0) processing. NCPDP standard field 463-EW. "^DD",9002313.02,9002313.0201,463,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,463,23,1,0) REQUEST CLAIM SEGMENT "^DD",9002313.02,9002313.0201,463,"DT") 3080104 "^DD",9002313.02,9002313.0201,464,0) INTERMEDIARY AUTHORIZATION ID^F^^460;4^K:$L(X)>13!($L(X)<13) X "^DD",9002313.02,9002313.0201,464,3) Answer must be 13 characters in length "^DD",9002313.02,9002313.0201,464,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,464,21,1,0) Value indicating intermediary authorization occurred. NCPDP standard "^DD",9002313.02,9002313.0201,464,21,2,0) field 464-EX. "^DD",9002313.02,9002313.0201,464,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,464,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,464,"DT") 3080104 "^DD",9002313.02,9002313.0201,465,0) PROVIDER ID QUALIFIER^F^^460;5^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,465,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,465,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,465,21,1,0) Code qualifying the Provider ID (444-E9). NCPDP standard field 465-EY. "^DD",9002313.02,9002313.0201,465,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,465,23,1,0) REQUEST PHARMACY PROVIDER SEGMENT. "^DD",9002313.02,9002313.0201,465,"DT") 3080104 "^DD",9002313.02,9002313.0201,466,0) PRESCRIBER ID QUALIFIER^F^^460;6^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,466,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,466,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,466,21,1,0) Code qualifying the Prescriber ID (411-DB). NCPDP standard field 466-EZ. "^DD",9002313.02,9002313.0201,466,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,466,23,1,0) REQUEST PRESCRIBER SEGMENT. "^DD",9002313.02,9002313.0201,466,"DT") 3080104 "^DD",9002313.02,9002313.0201,467,0) PRESCRIBER LOCATION CODE^F^^460;7^K:$L(X)>5!($L(X)<5) X "^DD",9002313.02,9002313.0201,467,3) Answer must be 5 characters in length "^DD",9002313.02,9002313.0201,467,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,467,21,1,0) Location address code assigned to the prescriber as identified in the "^DD",9002313.02,9002313.0201,467,21,2,0) National Provider System (NPS). NCPDP standard field 467-1E. "^DD",9002313.02,9002313.0201,467,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,467,23,1,0) REQUEST PRESCRIBER SEGMENT. "^DD",9002313.02,9002313.0201,467,"DT") 3080104 "^DD",9002313.02,9002313.0201,468,0) PRIMARY CARE PROVIDER ID QLFR^F^^460;8^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,468,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,468,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,468,21,1,0) Code qualifying the Primary Care Provider ID (421-DL). NCPDP standard "^DD",9002313.02,9002313.0201,468,21,2,0) field 468-2E. "^DD",9002313.02,9002313.0201,468,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,468,23,1,0) REQUEST PRESCRIBER SEGMENT. "^DD",9002313.02,9002313.0201,468,"DT") 3210330 "^DD",9002313.02,9002313.0201,469,0) PRIM CARE PROV LOCATION CODE^F^^460;9^K:$L(X)>5!($L(X)<5) X "^DD",9002313.02,9002313.0201,469,3) Answer must be 5 characters in length "^DD",9002313.02,9002313.0201,469,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,469,21,1,0) Location address code assigned to the primary care provider as identified "^DD",9002313.02,9002313.0201,469,21,2,0) in the National Provider System (NPS). NCPDP standard field 469-H5. "^DD",9002313.02,9002313.0201,469,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,469,23,1,0) REQUEST PRESCRIBER SEGMENT. "^DD",9002313.02,9002313.0201,469,"DT") 3210330 "^DD",9002313.02,9002313.0201,470,0) PRIM CARE PROVIDER LAST NAME^F^^460;10^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0201,470,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.0201,470,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,470,21,1,0) Last name of the Primary Care Provider. NCPDP standard field 470-4E. "^DD",9002313.02,9002313.0201,470,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,470,23,1,0) REQUEST PRESCRIBER SEGMENT. "^DD",9002313.02,9002313.0201,470,"DT") 3210330 "^DD",9002313.02,9002313.0201,471,0) OTHER PAYER REJECT COUNT^F^^470;1^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,471,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,471,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,471,21,1,0) Count of Other Payer Reject Code (472-6E) occurrences. NCPDP standard "^DD",9002313.02,9002313.0201,471,21,2,0) field 471-5E. "^DD",9002313.02,9002313.0201,471,23,0) ^.001^4^4^3101020^^^^ "^DD",9002313.02,9002313.0201,471,23,1,0) Number of reject codes identified by the previous "Other Payer" in "^DD",9002313.02,9002313.0201,471,23,2,0) Reject Count (510-FA). "^DD",9002313.02,9002313.0201,471,23,3,0) "^DD",9002313.02,9002313.0201,471,23,4,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.0201,471,"DT") 3080604 "^DD",9002313.02,9002313.0201,473.01,0) DUR PPS REPEATING FIELDS^9002313.1001A^^473.01;0 "^DD",9002313.02,9002313.0201,473.01,21,0) ^.001^1^1^3040126^^ "^DD",9002313.02,9002313.0201,473.01,21,1,0) Count of Drug Utilization sub-records. "^DD",9002313.02,9002313.0201,473.01,"DT") 3080102 "^DD",9002313.02,9002313.0201,477,0) PROF SERVICE FEE SUBMITTED^F^^470;7^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,477,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,477,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,477,21,1,0) Amount submitted by the provider for professional services rendered. "^DD",9002313.02,9002313.0201,477,21,2,0) NCPDP standard field 477-BE. "^DD",9002313.02,9002313.0201,477,23,0) ^.001^6^6^3101020^^^ "^DD",9002313.02,9002313.0201,477,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.0201,477,23,2,0) "^DD",9002313.02,9002313.0201,477,23,3,0) Examples: If the Professional Service Fee Submitted is $7.00, this field "^DD",9002313.02,9002313.0201,477,23,4,0) would reflect: 70{. "^DD",9002313.02,9002313.0201,477,23,5,0) "^DD",9002313.02,9002313.0201,477,23,6,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,477,"DT") 3210330 "^DD",9002313.02,9002313.0201,478,0) OTHER AMT CLAIMED SBMTTD COUNT^F^^470;8^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.0201,478,.1) OTHER AMOUNT CLAIMED SUBMITTED COUNT "^DD",9002313.02,9002313.0201,478,3) Answer must be 3 characters in length. "^DD",9002313.02,9002313.0201,478,21,0) ^.001^2^2^3101020^^^^ "^DD",9002313.02,9002313.0201,478,21,1,0) This is NCPDP field 478-H7 (Other Amount Claimed Submitted Count). "^DD",9002313.02,9002313.0201,478,21,2,0) It is the count of 'Other Amount Claimed Submitted' occurrences. "^DD",9002313.02,9002313.0201,478,23,0) ^.001^5^5^3101020^^^^ "^DD",9002313.02,9002313.0201,478,23,1,0) Fields included in the set/logical grouping are: "^DD",9002313.02,9002313.0201,478,23,2,0) Other Amount Claimed Submitted Qualifier (479-H8), "^DD",9002313.02,9002313.0201,478,23,3,0) Other Amount Claim Submitted (480-H9). "^DD",9002313.02,9002313.0201,478,23,4,0) "^DD",9002313.02,9002313.0201,478,23,5,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,478,"DT") 3210330 "^DD",9002313.02,9002313.0201,478.01,0) OTHER AMT CLAIMED MULTIPLE^9002313.0601A^^478.01;0 "^DD",9002313.02,9002313.0201,478.01,21,0) ^.001^1^1^3101020^^^^ "^DD",9002313.02,9002313.0201,478.01,21,1,0) This sub-file stores Other Amount Claimed values. "^DD",9002313.02,9002313.0201,478.01,"DT") 3101013 "^DD",9002313.02,9002313.0201,481,0) REGULATORY FEE AMT SUBMITTED^F^^480;1^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,481,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,481,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,481,21,1,0) Flat sales tax submitted for prescription. This amount is included in the "^DD",9002313.02,9002313.0201,481,21,2,0) Gross Amount Due (430-DU). NCPDP standard field 481-HA. "^DD",9002313.02,9002313.0201,481,23,0) ^^13^13^3080104^ "^DD",9002313.02,9002313.0201,481,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.0201,481,23,2,0) "^DD",9002313.02,9002313.0201,481,23,3,0) The submission of sales tax is governed by regulatory agencies (state, "^DD",9002313.02,9002313.0201,481,23,4,0) local, parish, etc). If the sales tax reported is a flat rate, then it is "^DD",9002313.02,9002313.0201,481,23,5,0) a fixed amount for a certain dollar value (for example for $xxx it is a "^DD",9002313.02,9002313.0201,481,23,6,0) certain amount). For example, for $1ØØ the flat rate is $1.99. This flat "^DD",9002313.02,9002313.0201,481,23,7,0) rate is then reported in Flat Sales Tax Amount Submitted "^DD",9002313.02,9002313.0201,481,23,8,0) (481-HA). "^DD",9002313.02,9002313.0201,481,23,9,0) "^DD",9002313.02,9002313.0201,481,23,10,0) Examples: If the flat sales tax amount submitted is $3.08, this "^DD",9002313.02,9002313.0201,481,23,11,0) field would reflect: 30H. "^DD",9002313.02,9002313.0201,481,23,12,0) "^DD",9002313.02,9002313.0201,481,23,13,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,481,"DT") 3210330 "^DD",9002313.02,9002313.0201,482,0) PERCENT TAX AMT SUBMITTED^F^^480;2^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,482,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,482,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,482,21,1,0) Percentage sales tax submitted. NCPDP standard field 482-GE. "^DD",9002313.02,9002313.0201,482,23,0) ^^9^9^3080104^ "^DD",9002313.02,9002313.0201,482,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.0201,482,23,2,0) "^DD",9002313.02,9002313.0201,482,23,3,0) Comments: The submission of sales tax is governed by regulatory agencies "^DD",9002313.02,9002313.0201,482,23,4,0) (state, local, parish, etc).. "^DD",9002313.02,9002313.0201,482,23,5,0) "^DD",9002313.02,9002313.0201,482,23,6,0) Examples: If the percentage sales tax amount submitted is $4.47, this "^DD",9002313.02,9002313.0201,482,23,7,0) field would reflect: 44G. "^DD",9002313.02,9002313.0201,482,23,8,0) "^DD",9002313.02,9002313.0201,482,23,9,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,482,"DT") 3210330 "^DD",9002313.02,9002313.0201,483,0) PERCENT TAX RATE SUBMITTED^F^^480;3^K:$L(X)>9!($L(X)<9) X "^DD",9002313.02,9002313.0201,483,3) Answer must be 9 characters in length "^DD",9002313.02,9002313.0201,483,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,483,21,1,0) Percentage sales tax rate used to calculate Percentage Sales Tax Amount "^DD",9002313.02,9002313.0201,483,21,2,0) Submitted (482-GE). NCPDP standard field 483-HE. "^DD",9002313.02,9002313.0201,483,23,0) ^^6^6^3080104^ "^DD",9002313.02,9002313.0201,483,23,1,0) The submission of sales tax is governed by regulatory agencies (state, "^DD",9002313.02,9002313.0201,483,23,2,0) local, parish, etc). "^DD",9002313.02,9002313.0201,483,23,3,0) "^DD",9002313.02,9002313.0201,483,23,4,0) Format=s999.9999 "^DD",9002313.02,9002313.0201,483,23,5,0) "^DD",9002313.02,9002313.0201,483,23,6,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,483,"DT") 3210330 "^DD",9002313.02,9002313.0201,484,0) PERCENTAGE TAX BASIS SBMTTD^F^^480;4^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,484,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,484,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,484,21,1,0) Code indicating the basis for percentage sales tax. NCPDP standard field "^DD",9002313.02,9002313.0201,484,21,2,0) 484-JE. "^DD",9002313.02,9002313.0201,484,23,0) ^^4^4^3080104^ "^DD",9002313.02,9002313.0201,484,23,1,0) The submission of sales tax is governed by regulatory agencies (state, "^DD",9002313.02,9002313.0201,484,23,2,0) local, parish, etc). "^DD",9002313.02,9002313.0201,484,23,3,0) "^DD",9002313.02,9002313.0201,484,23,4,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0201,484,"DT") 3210330 "^DD",9002313.02,9002313.0201,485,0) COUPON TYPE^F^^480;5^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,485,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,485,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,485,21,1,0) Code indicating the type of coupon being used. NCPDP standard field "^DD",9002313.02,9002313.0201,485,21,2,0) 485-KE. "^DD",9002313.02,9002313.0201,485,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,485,23,1,0) REQUEST COUPON SEGMENT. "^DD",9002313.02,9002313.0201,485,"DT") 3080104 "^DD",9002313.02,9002313.0201,486,0) COUPON NUMBER^F^^480;6^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0201,486,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.0201,486,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,486,21,1,0) Unique serial number assigned to the prescription coupons. NCPDP "^DD",9002313.02,9002313.0201,486,21,2,0) standard field 486-ME. "^DD",9002313.02,9002313.0201,486,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,486,23,1,0) REQUEST COUPON SEGMENT. "^DD",9002313.02,9002313.0201,486,"DT") 3080104 "^DD",9002313.02,9002313.0201,487,0) COUPON VALUE AMOUNT^F^^480;7^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,487,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,487,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,487,21,1,0) Value of the coupon. NCPDP standard field 487-NE. "^DD",9002313.02,9002313.0201,487,23,0) ^^6^6^3080104^ "^DD",9002313.02,9002313.0201,487,23,1,0) Format=s$$$$$$vcc "^DD",9002313.02,9002313.0201,487,23,2,0) "^DD",9002313.02,9002313.0201,487,23,3,0) Examples: If the coupon value amount is $10.00, this field would reflect: "^DD",9002313.02,9002313.0201,487,23,4,0) 100{. "^DD",9002313.02,9002313.0201,487,23,5,0) "^DD",9002313.02,9002313.0201,487,23,6,0) REQUEST COUPON SEGMENT. "^DD",9002313.02,9002313.0201,487,"DT") 3080104 "^DD",9002313.02,9002313.0201,491,0) DIAGNOSIS CODE COUNT^F^^490;1^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.0201,491,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.0201,491,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,491,21,1,0) Count of diagnosis occurrences. NCPDP standard field 491-VE. "^DD",9002313.02,9002313.0201,491,23,0) ^^4^4^3080104^ "^DD",9002313.02,9002313.0201,491,23,1,0) Fields included in the set/logical grouping are: "^DD",9002313.02,9002313.0201,491,23,2,0) Diagnosis Code Qualifier (492-WE) "^DD",9002313.02,9002313.0201,491,23,3,0) Diagnosis Code (424-DO) "^DD",9002313.02,9002313.0201,491,23,4,0) REQUEST CLINICAL SEGMENT. "^DD",9002313.02,9002313.0201,491,"DT") 3080104 "^DD",9002313.02,9002313.0201,491.01,0) CLINICAL DIAGNOSIS^9002313.0701A^^491.01;0 "^DD",9002313.02,9002313.0201,491.01,21,0) ^^1^1^3080102^ "^DD",9002313.02,9002313.0201,491.01,21,1,0) Diagnosis sub-records. "^DD",9002313.02,9002313.0201,491.01,"DT") 3080102 "^DD",9002313.02,9002313.0201,493,0) CLINICAL INFORMATION COUNTER^F^^493;1^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.0201,493,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.0201,493,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,493,21,1,0) Counter number of clinical information measurement set/logical grouping. "^DD",9002313.02,9002313.0201,493,21,2,0) NCPDP standard field 493-XE. "^DD",9002313.02,9002313.0201,493,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,493,23,1,0) REQUEST CLINICAL SEGMENT. "^DD",9002313.02,9002313.0201,493,"DT") 3210330 "^DD",9002313.02,9002313.0201,493.01,0) CLINICAL INFORMATION^9002313.0801A^^493.01;0 "^DD",9002313.02,9002313.0201,493.01,21,0) ^.001^1^1^3040126^^^ "^DD",9002313.02,9002313.0201,493.01,21,1,0) Count of clinical information sub-records. "^DD",9002313.02,9002313.0201,493.01,"DT") 3080102 "^DD",9002313.02,9002313.0201,498.01,0) REQUEST TYPE^F^^498;1^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.0201,498.01,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.0201,498.01,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,498.01,21,1,0) Code identifying type of prior authorization request. NCPDP standard "^DD",9002313.02,9002313.0201,498.01,21,2,0) field 498-PA. "^DD",9002313.02,9002313.0201,498.01,23,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,498.01,23,1,0) Used by processor to distinguish reason for prior authorization request. "^DD",9002313.02,9002313.0201,498.01,23,2,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.01,"DT") 3080104 "^DD",9002313.02,9002313.0201,498.02,0) REQUEST PERIOD DATE-BEGIN^F^^498;2^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,498.02,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,498.02,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,498.02,21,1,0) Beginning date for a prior authorization request. NCPDP standard field "^DD",9002313.02,9002313.0201,498.02,21,2,0) 498-PB. "^DD",9002313.02,9002313.0201,498.02,23,0) ^^11^11^3080104^ "^DD",9002313.02,9002313.0201,498.02,23,1,0) Format=CCYYMMDD "^DD",9002313.02,9002313.0201,498.02,23,2,0) "^DD",9002313.02,9002313.0201,498.02,23,3,0) CC=Century "^DD",9002313.02,9002313.0201,498.02,23,4,0) YY=Year "^DD",9002313.02,9002313.0201,498.02,23,5,0) MM=Month "^DD",9002313.02,9002313.0201,498.02,23,6,0) DD=Day "^DD",9002313.02,9002313.0201,498.02,23,7,0) "^DD",9002313.02,9002313.0201,498.02,23,8,0) Used by processor to determine starting date of a prior authorization "^DD",9002313.02,9002313.0201,498.02,23,9,0) request. "^DD",9002313.02,9002313.0201,498.02,23,10,0) "^DD",9002313.02,9002313.0201,498.02,23,11,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.02,"DT") 3210330 "^DD",9002313.02,9002313.0201,498.03,0) REQUEST PERIOD DATE-END^F^^498;3^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0201,498.03,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0201,498.03,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,498.03,21,1,0) End date for a prior authorization request. NCPDP standard field 498-PC. "^DD",9002313.02,9002313.0201,498.03,23,0) ^^10^10^3080104^ "^DD",9002313.02,9002313.0201,498.03,23,1,0) Format=CCYYMMDD "^DD",9002313.02,9002313.0201,498.03,23,2,0) "^DD",9002313.02,9002313.0201,498.03,23,3,0) CC=Century "^DD",9002313.02,9002313.0201,498.03,23,4,0) YY=Year "^DD",9002313.02,9002313.0201,498.03,23,5,0) MM=Month "^DD",9002313.02,9002313.0201,498.03,23,6,0) DD=Day "^DD",9002313.02,9002313.0201,498.03,23,7,0) Used by processor to determine the ending date for a prior authorization "^DD",9002313.02,9002313.0201,498.03,23,8,0) request. "^DD",9002313.02,9002313.0201,498.03,23,9,0) "^DD",9002313.02,9002313.0201,498.03,23,10,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.03,"DT") 3210330 "^DD",9002313.02,9002313.0201,498.04,0) BASIS OF REQUEST^F^^498;4^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,498.04,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,498.04,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,498.04,21,1,0) Code describing the reason for prior authorization request. NCPDP "^DD",9002313.02,9002313.0201,498.04,21,2,0) standard field 498-PD. "^DD",9002313.02,9002313.0201,498.04,23,0) ^^3^3^3080104^ "^DD",9002313.02,9002313.0201,498.04,23,1,0) Used by processor to determine appropriate modules and editing for the "^DD",9002313.02,9002313.0201,498.04,23,2,0) prior authorization transaction. "^DD",9002313.02,9002313.0201,498.04,23,3,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.04,"DT") 3080104 "^DD",9002313.02,9002313.0201,498.05,0) AUTHORIZED REP FIRST NAME^F^^498;5^K:$L(X)>14!($L(X)<14) X "^DD",9002313.02,9002313.0201,498.05,3) Answer must be 14 characters in length "^DD",9002313.02,9002313.0201,498.05,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,498.05,21,1,0) First name of the patients authorized representative. NCPDP standard "^DD",9002313.02,9002313.0201,498.05,21,2,0) field 498-PE. "^DD",9002313.02,9002313.0201,498.05,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,498.05,23,1,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.05,"DT") 3080104 "^DD",9002313.02,9002313.0201,498.06,0) AUTHORIZED REP LAST NAME^F^^498;6^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0201,498.06,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.0201,498.06,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,498.06,21,1,0) Last name of the patients authorized representative. NCPDP standard "^DD",9002313.02,9002313.0201,498.06,21,2,0) field 498-PF. "^DD",9002313.02,9002313.0201,498.06,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,498.06,23,1,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.06,"DT") 3080104 "^DD",9002313.02,9002313.0201,498.07,0) AUTHORIZED REP STREET ADDRESS^F^^498;7^K:$L(X)>32!($L(X)<32) X "^DD",9002313.02,9002313.0201,498.07,3) Answer must be 32 characters in length "^DD",9002313.02,9002313.0201,498.07,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,498.07,21,1,0) Free-form text for address information. NCPDP standard field 498-PG. "^DD",9002313.02,9002313.0201,498.07,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,498.07,23,1,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.07,"DT") 3080104 "^DD",9002313.02,9002313.0201,498.08,0) AUTH REP CITY ADDRESS^F^^498;8^K:$L(X)>22!($L(X)<22) X "^DD",9002313.02,9002313.0201,498.08,3) Answer must be 22 characters in length "^DD",9002313.02,9002313.0201,498.08,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,498.08,21,1,0) Free-form text for city name. NCPDP standard field 498-PH. "^DD",9002313.02,9002313.0201,498.08,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,498.08,23,1,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.08,"DT") 3210330 "^DD",9002313.02,9002313.0201,498.09,0) AUTHORIZED REP STATE/PROV ADDR^F^^498;9^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,498.09,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0201,498.09,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,498.09,21,1,0) Authorized Rep's State or Province. NCPDP standard field 498-PJ. "^DD",9002313.02,9002313.0201,498.09,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,498.09,23,1,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.09,"DT") 3210330 "^DD",9002313.02,9002313.0201,498.11,0) AUTHORIZED REP ZIP/POSTAL ZONE^F^^498;11^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0201,498.11,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.0201,498.11,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,498.11,21,1,0) Authorized Rep's Zip Code. NCPDP standard field 498-PK. "^DD",9002313.02,9002313.0201,498.11,23,0) ^^4^4^3080104^ "^DD",9002313.02,9002313.0201,498.11,23,1,0) This left-justified field contains the five-digit zip code, and may "^DD",9002313.02,9002313.0201,498.11,23,2,0) include the four-digit expanded zip code in which the patient's "^DD",9002313.02,9002313.0201,498.11,23,3,0) authorized representative is located. "^DD",9002313.02,9002313.0201,498.11,23,4,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.11,"DT") 3210330 "^DD",9002313.02,9002313.0201,498.12,0) PRESCRIBER TELEPHONE NUMBER^F^^498;12^K:$L(X)>12!($L(X)<12) X "^DD",9002313.02,9002313.0201,498.12,3) Answer must be 12 characters in length "^DD",9002313.02,9002313.0201,498.12,21,0) ^.001^1^1^3141231^^ "^DD",9002313.02,9002313.0201,498.12,21,1,0) Ten digit phone number of the prescriber. NCPDP standard field 498-PM. "^DD",9002313.02,9002313.0201,498.12,23,0) ^.001^10^10^3141231^^ "^DD",9002313.02,9002313.0201,498.12,23,1,0) Format=AAAEEENNNN "^DD",9002313.02,9002313.0201,498.12,23,2,0) "^DD",9002313.02,9002313.0201,498.12,23,3,0) AAA=Area Code "^DD",9002313.02,9002313.0201,498.12,23,4,0) EEE=Exchange Code "^DD",9002313.02,9002313.0201,498.12,23,5,0) NNNN=Number "^DD",9002313.02,9002313.0201,498.12,23,6,0) "^DD",9002313.02,9002313.0201,498.12,23,7,0) Examples: This field would reflect the telephone number of (414) 555-1212 "^DD",9002313.02,9002313.0201,498.12,23,8,0) as 4145551212. "^DD",9002313.02,9002313.0201,498.12,23,9,0) "^DD",9002313.02,9002313.0201,498.12,23,10,0) REQUEST PRESCRIBER SEGMENT. "^DD",9002313.02,9002313.0201,498.12,"DT") 3141231 "^DD",9002313.02,9002313.0201,498.13,0) PRIOR AUTH SUPPORTING DOCUMENT^9002313.0901^^498.13;0 "^DD",9002313.02,9002313.0201,498.13,21,0) ^.001^2^2^3101020^^^^ "^DD",9002313.02,9002313.0201,498.13,21,1,0) This is a free text message. "^DD",9002313.02,9002313.0201,498.13,21,2,0) It is NCPDP field 498-PP. "^DD",9002313.02,9002313.0201,498.13,23,0) ^.001^4^4^3101020^^^^ "^DD",9002313.02,9002313.0201,498.13,23,1,0) Could be used, if applicable, to supply information not already included "^DD",9002313.02,9002313.0201,498.13,23,2,0) in NCPDP data fields that may be required to process a prior "^DD",9002313.02,9002313.0201,498.13,23,3,0) authorization transaction. "^DD",9002313.02,9002313.0201,498.13,23,4,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.13,"DT") 3210330 "^DD",9002313.02,9002313.0201,498.14,0) PRIOR AUTH NUMBER-ASSIGNED^F^^498;14^K:$L(X)>13!($L(X)<13) X "^DD",9002313.02,9002313.0201,498.14,3) Answer must be 13 characters in length "^DD",9002313.02,9002313.0201,498.14,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,498.14,21,1,0) Unique number identifying the prior authorization assigned by the "^DD",9002313.02,9002313.0201,498.14,21,2,0) processor. NCPDP standard field 498-PY. "^DD",9002313.02,9002313.0201,498.14,23,0) ^^4^4^3080104^ "^DD",9002313.02,9002313.0201,498.14,23,1,0) Provided to the pharmacy by the processor to be used by the pharmacy for "^DD",9002313.02,9002313.0201,498.14,23,2,0) billing, and if applicable, reversal purposes. "^DD",9002313.02,9002313.0201,498.14,23,3,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.14,23,4,0) RESPONSE PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,498.14,"DT") 3210330 "^DD",9002313.02,9002313.0201,503,0) AUTHORIZATION NUMBER^F^^500;3^K:$L(X)>22!($L(X)<22) X "^DD",9002313.02,9002313.0201,503,3) Answer must be 22 characters in length "^DD",9002313.02,9002313.0201,503,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,503,21,1,0) Unique number identifying the prior authorization assigned by the "^DD",9002313.02,9002313.0201,503,21,2,0) processor. NCPDP standard field 503-F3. "^DD",9002313.02,9002313.0201,503,23,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0201,503,23,1,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0201,503,23,2,0) RESPONSE STATUS SEGMENT. "^DD",9002313.02,9002313.0201,503,"DT") 3080104 "^DD",9002313.02,9002313.0201,579,0) ASSOC RX/SERVICE PROV ID QUAL^F^^570;9^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,579,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,579,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,579,21,1,0) NCPDP Standard field 579-XX "^DD",9002313.02,9002313.0201,579,21,2,0) "^DD",9002313.02,9002313.0201,579,21,3,0) Code qualifying the 'Associated Prescription/Service Provider ID' "^DD",9002313.02,9002313.0201,579,21,4,0) (58Ø-XY) to which the claim/service is related. "^DD",9002313.02,9002313.0201,579,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,579,23,1,0) CLAIM SEGMENT "^DD",9002313.02,9002313.0201,579,"DT") 3210330 "^DD",9002313.02,9002313.0201,580,0) ASSOC RX/SERVICE PROVIDER ID^F^^570;10^K:$L(X)>17!($L(X)<1) X "^DD",9002313.02,9002313.0201,580,3) Answer must be 1-17 characters in length. "^DD",9002313.02,9002313.0201,580,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,580,21,1,0) NCPDP Standard field 580-XY "^DD",9002313.02,9002313.0201,580,21,2,0) "^DD",9002313.02,9002313.0201,580,21,3,0) Related Service Provider ID to which the claim/service is associated. "^DD",9002313.02,9002313.0201,580,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,580,23,1,0) CLAIM SEGMENT "^DD",9002313.02,9002313.0201,580,"DT") 3210330 "^DD",9002313.02,9002313.0201,581,0) ASSOC RX/SERVICE REF NUM QUAL^F^^580;1^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,581,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,581,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,581,21,1,0) NCPDP Standard field 581-XZ "^DD",9002313.02,9002313.0201,581,21,2,0) "^DD",9002313.02,9002313.0201,581,21,3,0) Code qualifying the 'Associated Prescription/Service Reference Number ID' "^DD",9002313.02,9002313.0201,581,21,4,0) (456-EN) to which the claim/service is related. "^DD",9002313.02,9002313.0201,581,23,0) ^^1^1^3130301^^ "^DD",9002313.02,9002313.0201,581,23,1,0) CLAIM SEGMENT "^DD",9002313.02,9002313.0201,581,"DT") 3210330 "^DD",9002313.02,9002313.0201,582,0) ASSOC RX/SERVICE FILL NUMBER^F^^580;2^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,582,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,582,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,582,21,1,0) NCPDP Standard field 582-X0 "^DD",9002313.02,9002313.0201,582,21,2,0) "^DD",9002313.02,9002313.0201,582,21,3,0) Related Fill Number to which the claim/service is associated. "^DD",9002313.02,9002313.0201,582,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,582,23,1,0) CLAIM SEGMENT "^DD",9002313.02,9002313.0201,582,"DT") 3210330 "^DD",9002313.02,9002313.0201,583,0) SERVICE PROVIDER NAME^F^^580;3^K:$L(X)>32!($L(X)<1) X "^DD",9002313.02,9002313.0201,583,3) Answer must be 1-32 characters in length. "^DD",9002313.02,9002313.0201,583,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,583,21,1,0) NCPDP Standard field 583-YK "^DD",9002313.02,9002313.0201,583,21,2,0) "^DD",9002313.02,9002313.0201,583,21,3,0) The name of the service provider business associated to the service "^DD",9002313.02,9002313.0201,583,21,4,0) provider ID (2Ø1-B1). "^DD",9002313.02,9002313.0201,583,23,0) ^^1^1^3130322^ "^DD",9002313.02,9002313.0201,583,23,1,0) SERVICE PROVIDER SEGMENT "^DD",9002313.02,9002313.0201,583,"DT") 3130322 "^DD",9002313.02,9002313.0201,584,0) SERVICE PROVIDER STREET^F^^580;4^K:$L(X)>32!($L(X)<1) X "^DD",9002313.02,9002313.0201,584,3) Answer must be 1-32 characters in length. "^DD",9002313.02,9002313.0201,584,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,584,21,1,0) NCPCP Standard field 584-YM "^DD",9002313.02,9002313.0201,584,21,2,0) "^DD",9002313.02,9002313.0201,584,21,3,0) The street address of the service provider. "^DD",9002313.02,9002313.0201,584,23,0) ^^1^1^3130322^ "^DD",9002313.02,9002313.0201,584,23,1,0) SERVICE PROVIDER SEGMENT "^DD",9002313.02,9002313.0201,584,"DT") 3130322 "^DD",9002313.02,9002313.0201,585,0) SERVICE PROVIDER CITY^F^^580;5^K:$L(X)>22!($L(X)<1) X "^DD",9002313.02,9002313.0201,585,3) Answer must be 1-22 characters in length. "^DD",9002313.02,9002313.0201,585,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,585,21,1,0) NCPDP Standard field 585-YN "^DD",9002313.02,9002313.0201,585,21,2,0) "^DD",9002313.02,9002313.0201,585,21,3,0) Code uniquely identifying the transmission syntax and corresponding Data "^DD",9002313.02,9002313.0201,585,21,4,0) Dictionary. "^DD",9002313.02,9002313.0201,585,23,0) ^^1^1^3130322^ "^DD",9002313.02,9002313.0201,585,23,1,0) SERVICE PROVIDER SEGMENT "^DD",9002313.02,9002313.0201,585,"DT") 3130322 "^DD",9002313.02,9002313.0201,586,0) SERVICE PROVIDE STATE/PROVINCE^F^^580;6^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,586,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,586,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,586,21,1,0) NCPDP Standard field 586-YP "^DD",9002313.02,9002313.0201,586,21,2,0) "^DD",9002313.02,9002313.0201,586,21,3,0) The state/province code of the address of the service provider. "^DD",9002313.02,9002313.0201,586,23,0) ^^1^1^3130322^ "^DD",9002313.02,9002313.0201,586,23,1,0) SERVICE PROVIDER SEGMENT "^DD",9002313.02,9002313.0201,586,"DT") 3130322 "^DD",9002313.02,9002313.0201,587,0) SERVICE PROVIDER ZIP/POST CODE^F^^580;7^K:$L(X)>17!($L(X)<1) X "^DD",9002313.02,9002313.0201,587,3) Answer must be 1-17 characters in length. "^DD",9002313.02,9002313.0201,587,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,587,21,1,0) NCPDP Standard field number 587-YQ "^DD",9002313.02,9002313.0201,587,21,2,0) "^DD",9002313.02,9002313.0201,587,21,3,0) The postal code of the address of the service provider. "^DD",9002313.02,9002313.0201,587,23,0) ^^1^1^3130322^ "^DD",9002313.02,9002313.0201,587,23,1,0) SERVICE PROVIDER SEGMENT "^DD",9002313.02,9002313.0201,587,"DT") 3130322 "^DD",9002313.02,9002313.0201,590,0) SELLER INITIALS^F^^580;10^K:$L(X)>5!($L(X)<1) X "^DD",9002313.02,9002313.0201,590,3) Answer must be 1-5 characters in length. "^DD",9002313.02,9002313.0201,590,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,590,21,1,0) NCPDP Standard field 590-YT "^DD",9002313.02,9002313.0201,590,21,2,0) "^DD",9002313.02,9002313.0201,590,21,3,0) The initials of the person responsible for dispensing the prescription or "^DD",9002313.02,9002313.0201,590,21,4,0) provision of service. "^DD",9002313.02,9002313.0201,590,23,0) ^^1^1^3130322^ "^DD",9002313.02,9002313.0201,590,23,1,0) SERVICE PROVIDER SEGMENT "^DD",9002313.02,9002313.0201,590,"DT") 3130322 "^DD",9002313.02,9002313.0201,591,0) PURCHASER ID QUALIFIER^F^^590;1^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,591,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,591,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,591,21,1,0) NCPDP Standard field 591-YU "^DD",9002313.02,9002313.0201,591,21,2,0) "^DD",9002313.02,9002313.0201,591,21,3,0) Code indicating the type of ID used in the Purchaser ID field. Qualifies "^DD",9002313.02,9002313.0201,591,21,4,0) Purchaser ID (592-YV). "^DD",9002313.02,9002313.0201,591,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,591,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,591,"DT") 3130301 "^DD",9002313.02,9002313.0201,592,0) PURCHASER ID^F^^590;2^K:$L(X)>22!($L(X)<1) X "^DD",9002313.02,9002313.0201,592,3) Answer must be 1-22 characters in length. "^DD",9002313.02,9002313.0201,592,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,592,21,1,0) NCPDP Standard field 592-YV "^DD",9002313.02,9002313.0201,592,21,2,0) "^DD",9002313.02,9002313.0201,592,21,3,0) The ID number used to identify the purchaser of the product/service. "^DD",9002313.02,9002313.0201,592,21,4,0) Qualified by Purchaser ID Qualifier. "^DD",9002313.02,9002313.0201,592,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,592,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,592,"DT") 3130301 "^DD",9002313.02,9002313.0201,593,0) PURCHASER ID STATE/PROVINCE^F^^590;3^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,593,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,593,21,0) ^^5^5^3130301^ "^DD",9002313.02,9002313.0201,593,21,1,0) NCPDP Standard field 593-YW "^DD",9002313.02,9002313.0201,593,21,2,0) "^DD",9002313.02,9002313.0201,593,21,3,0) The postal state code abbreviation that is used in conjunction with the "^DD",9002313.02,9002313.0201,593,21,4,0) Purchaser ID Qualifier and Purchaser ID fields to identify what state the "^DD",9002313.02,9002313.0201,593,21,5,0) identification is from. "^DD",9002313.02,9002313.0201,593,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,593,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,593,"DT") 3130301 "^DD",9002313.02,9002313.0201,594,0) PURCHASER DATE OF BIRTH^F^^590;4^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.0201,594,3) Answer must be 1-10 characters in length. "^DD",9002313.02,9002313.0201,594,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,594,21,1,0) NCPDP Standard field 594-YX "^DD",9002313.02,9002313.0201,594,21,2,0) "^DD",9002313.02,9002313.0201,594,21,3,0) The Date of Birth of the purchaser of the product/service. "^DD",9002313.02,9002313.0201,594,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,594,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,594,"DT") 3130301 "^DD",9002313.02,9002313.0201,595,0) PURCHASER GENDER CODE^F^^590;5^K:$L(X)>3!($L(X)<1) X "^DD",9002313.02,9002313.0201,595,3) Answer must be 1-3 characters in length. "^DD",9002313.02,9002313.0201,595,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,595,21,1,0) NCPDP Standard field 595-YY "^DD",9002313.02,9002313.0201,595,21,2,0) "^DD",9002313.02,9002313.0201,595,21,3,0) The Gender of the purchaser of the product/service. "^DD",9002313.02,9002313.0201,595,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,595,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,595,"DT") 3130301 "^DD",9002313.02,9002313.0201,596,0) PURCHASER FIRST NAME^F^^590;6^K:$L(X)>14!($L(X)<1) X "^DD",9002313.02,9002313.0201,596,3) Answer must be 1-14 characters in length. "^DD",9002313.02,9002313.0201,596,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,596,21,1,0) NCPDP Standard field 596-YZ "^DD",9002313.02,9002313.0201,596,21,2,0) "^DD",9002313.02,9002313.0201,596,21,3,0) The First Name of the purchaser of the product/service. "^DD",9002313.02,9002313.0201,596,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,596,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,596,"DT") 3130301 "^DD",9002313.02,9002313.0201,597,0) PURCHASER LAST NAME^F^^590;7^K:$L(X)>17!($L(X)<1) X "^DD",9002313.02,9002313.0201,597,3) Answer must be 1-17 characters in length. "^DD",9002313.02,9002313.0201,597,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,597,21,1,0) NCPDP Standard field 597-Y0 "^DD",9002313.02,9002313.0201,597,21,2,0) "^DD",9002313.02,9002313.0201,597,21,3,0) The Last Name of the purchaser of the product/service. "^DD",9002313.02,9002313.0201,597,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,597,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,597,"DT") 3130301 "^DD",9002313.02,9002313.0201,598,0) PURCHASER STREET ADDRESS^F^^590;8^K:$L(X)>32!($L(X)<1) X "^DD",9002313.02,9002313.0201,598,3) Answer must be 1-32 characters in length. "^DD",9002313.02,9002313.0201,598,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,598,21,1,0) NCPDP Standard field 598-Y1 "^DD",9002313.02,9002313.0201,598,21,2,0) "^DD",9002313.02,9002313.0201,598,21,3,0) Free-form text for address information. "^DD",9002313.02,9002313.0201,598,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,598,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,598,"DT") 3130301 "^DD",9002313.02,9002313.0201,599,0) PURCHASER CITY ADDRESS^F^^590;9^K:$L(X)>22!($L(X)<1) X "^DD",9002313.02,9002313.0201,599,3) Answer must be 1-22 characters in length. "^DD",9002313.02,9002313.0201,599,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,599,21,1,0) NCPDP Standard field 599-Y2 "^DD",9002313.02,9002313.0201,599,21,2,0) "^DD",9002313.02,9002313.0201,599,21,3,0) The City name associated to the address of the purchaser of the "^DD",9002313.02,9002313.0201,599,21,4,0) product/service. "^DD",9002313.02,9002313.0201,599,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,599,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,599,"DT") 3130301 "^DD",9002313.02,9002313.0201,600,0) UNIT OF MEASURE^F^^600;1^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0201,600,3) Enter the Unit of Measure (4 characters) "^DD",9002313.02,9002313.0201,600,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,600,21,1,0) Unit of measure of the prescription. NCPDP standard field 600-28. "^DD",9002313.02,9002313.0201,600,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0201,600,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.0201,600,"DT") 3080104 "^DD",9002313.02,9002313.0201,675,0) PURCHASER STATE/PROVINCE CODE^F^^670;5^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,675,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,675,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,675,21,1,0) NCPDP Standard field 675-Y3 "^DD",9002313.02,9002313.0201,675,21,2,0) "^DD",9002313.02,9002313.0201,675,21,3,0) The Postal State/province code associated to the address of the purchaser "^DD",9002313.02,9002313.0201,675,21,4,0) of the product/service. "^DD",9002313.02,9002313.0201,675,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,675,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,675,"DT") 3130301 "^DD",9002313.02,9002313.0201,676,0) PURCHASER ZIP/POSTAL CODE^F^^670;6^K:$L(X)>17!($L(X)<1) X "^DD",9002313.02,9002313.0201,676,3) Answer must be 1-17 characters in length. "^DD",9002313.02,9002313.0201,676,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,676,21,1,0) NCPDP Standard field 676-Y4 "^DD",9002313.02,9002313.0201,676,21,2,0) "^DD",9002313.02,9002313.0201,676,21,3,0) The associated postal code of the address of the purchaser of the "^DD",9002313.02,9002313.0201,676,21,4,0) product/service. "^DD",9002313.02,9002313.0201,676,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,676,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,676,"DT") 3130301 "^DD",9002313.02,9002313.0201,677,0) PURCHASER COUNTRY CODE^F^^670;7^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,677,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,677,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,677,21,1,0) NCPDP Standard field 677-Y5 "^DD",9002313.02,9002313.0201,677,21,2,0) "^DD",9002313.02,9002313.0201,677,21,3,0) The associated Postal country code of the purchaser of the "^DD",9002313.02,9002313.0201,677,21,4,0) product/service. "^DD",9002313.02,9002313.0201,677,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,677,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,677,"DT") 3130301 "^DD",9002313.02,9002313.0201,678,0) TIME OF SERVICE^F^^670;8^K:$L(X)>8!($L(X)<1) X "^DD",9002313.02,9002313.0201,678,3) Answer must be 1-8 characters in length. "^DD",9002313.02,9002313.0201,678,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,678,21,1,0) NCPDP Standard field 678-Y6 "^DD",9002313.02,9002313.0201,678,21,2,0) "^DD",9002313.02,9002313.0201,678,21,3,0) The time at which the service is performed as local time that will "^DD",9002313.02,9002313.0201,678,21,4,0) correspond with the actual date of service. "^DD",9002313.02,9002313.0201,678,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,678,23,1,0) CLAIM SEGMENT "^DD",9002313.02,9002313.0201,678,"DT") 3130301 "^DD",9002313.02,9002313.0201,679,0) SELLER ID^F^^670;9^K:$L(X)>72!($L(X)<1) X "^DD",9002313.02,9002313.0201,679,3) Answer must be 1-72 characters in length. "^DD",9002313.02,9002313.0201,679,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,679,21,1,0) NCPDP Standard field 679-Y9 "^DD",9002313.02,9002313.0201,679,21,2,0) "^DD",9002313.02,9002313.0201,679,21,3,0) The identification of the person responsible for dispensing the "^DD",9002313.02,9002313.0201,679,21,4,0) prescription or provision of the service. "^DD",9002313.02,9002313.0201,679,23,0) ^^1^1^3130322^ "^DD",9002313.02,9002313.0201,679,23,1,0) SERVICE PROVIDER SEGMENT "^DD",9002313.02,9002313.0201,679,"DT") 3130322 "^DD",9002313.02,9002313.0201,680,0) SELLER ID QUALIFIER^F^^670;10^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,680,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,680,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,680,21,1,0) NCPDP Standard field 680-ZB "^DD",9002313.02,9002313.0201,680,21,2,0) "^DD",9002313.02,9002313.0201,680,21,3,0) Code indicating the type of ID used in the Seller Identification (xxx-xx). "^DD",9002313.02,9002313.0201,680,23,0) ^^1^1^3130322^ "^DD",9002313.02,9002313.0201,680,23,1,0) SERVICE PROVIDER SEGMENT "^DD",9002313.02,9002313.0201,680,"DT") 3130322 "^DD",9002313.02,9002313.0201,681,0) SALES TRANSACTION ID^F^^680;1^K:$L(X)>82!($L(X)<1) X "^DD",9002313.02,9002313.0201,681,3) Answer must be 1-82 characters in length. "^DD",9002313.02,9002313.0201,681,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,681,21,1,0) NCPDP Standard field 681-ZF "^DD",9002313.02,9002313.0201,681,21,2,0) "^DD",9002313.02,9002313.0201,681,21,3,0) A reference identifier assigned to the sale transaction as assigned by "^DD",9002313.02,9002313.0201,681,21,4,0) the merchant. "^DD",9002313.02,9002313.0201,681,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,681,23,1,0) CLAIM SEGMENT "^DD",9002313.02,9002313.0201,681,"DT") 3130301 "^DD",9002313.02,9002313.0201,880,0) TRANSACTION REFERENCE NUMBER^F^^870;10^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.0201,880,3) Answer must be 1-10 characters. "^DD",9002313.02,9002313.0201,880,21,0) ^.001^4^4^3101005^^^^ "^DD",9002313.02,9002313.0201,880,21,1,0) This is used to store NCPDP field 880-K5 (Transaction Reference Number), "^DD",9002313.02,9002313.0201,880,21,2,0) which is defined as "A reference number assigned by the provider to each of the data records in the batch or real-time transactions. "^DD",9002313.02,9002313.0201,880,21,3,0) The purpose of this number is to facilitate the process of matching the transaction response to the transaction. "^DD",9002313.02,9002313.0201,880,21,4,0) The transaction reference number assigned should be returned in the response." "^DD",9002313.02,9002313.0201,880,"DT") 3100727 "^DD",9002313.02,9002313.0201,995,0) ROUTE OF ADMINISTRATION^F^^990;5^K:$L(X)>11!($L(X)<1) X "^DD",9002313.02,9002313.0201,995,3) Answer must be 1-11 characters. "^DD",9002313.02,9002313.0201,995,21,0) ^.001^2^2^3100929^^ "^DD",9002313.02,9002313.0201,995,21,1,0) This is used to store NCPDP field 995-E2 (Route of Administration), "^DD",9002313.02,9002313.0201,995,21,2,0) which is defined as "This is an override to the default route referenced for the product. For a multi-ingredient compound, it is the route of the complete compound mixture." "^DD",9002313.02,9002313.0201,995,"DT") 3100727 "^DD",9002313.02,9002313.0201,996,0) COMPOUND TYPE^F^^990;6^K:$L(X)>2!($L(X)<1) X "^DD",9002313.02,9002313.0201,996,3) Answer must be 1-2 characters. "^DD",9002313.02,9002313.0201,996,21,0) ^.001^2^2^3100929^^^ "^DD",9002313.02,9002313.0201,996,21,1,0) This is used to store NCPDP field 996-G1 (Compound Type), "^DD",9002313.02,9002313.0201,996,21,2,0) which is defined as "Clarifies the type of compound." "^DD",9002313.02,9002313.0201,996,"DT") 3100727 "^DD",9002313.02,9002313.0201,1023,0) PURCHASER RELATIONSHIP CODE^F^^A20;3^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,1023,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,1023,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,1023,21,1,0) NCPDP Standard field A23-YS "^DD",9002313.02,9002313.0201,1023,21,2,0) "^DD",9002313.02,9002313.0201,1023,21,3,0) Code indicating the relationship from purchaser to patient. "^DD",9002313.02,9002313.0201,1023,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,1023,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,1023,"DT") 3130301 "^DD",9002313.02,9002313.0201,1024,0) PRESCRIBER ID STATE/PROVINCE^F^^A20;4^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,1024,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,1024,21,0) ^^5^5^3130301^ "^DD",9002313.02,9002313.0201,1024,21,1,0) NCPDP Standard field A24-ZK "^DD",9002313.02,9002313.0201,1024,21,2,0) "^DD",9002313.02,9002313.0201,1024,21,3,0) The postal state code abbreviation that is used in conjunction with the "^DD",9002313.02,9002313.0201,1024,21,4,0) Prescriber ID Qualifier and the Prescriber ID fields to identify what "^DD",9002313.02,9002313.0201,1024,21,5,0) state the identification is from. "^DD",9002313.02,9002313.0201,1024,23,0) ^^1^1^3130301^^ "^DD",9002313.02,9002313.0201,1024,23,1,0) PRESCRIBER SEGMENT "^DD",9002313.02,9002313.0201,1024,"DT") 3130301 "^DD",9002313.02,9002313.0201,1025,0) PRESCRIBER ALTERNATE ID QUAL^F^^A20;5^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,1025,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,1025,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,1025,21,1,0) NCPDP Standard field A25-ZM "^DD",9002313.02,9002313.0201,1025,21,2,0) "^DD",9002313.02,9002313.0201,1025,21,3,0) A code qualifying the Prescriber Alternate ID (A26-ZP) "^DD",9002313.02,9002313.0201,1025,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,1025,23,1,0) PRESCRIBER SEGMENT "^DD",9002313.02,9002313.0201,1025,"DT") 3130301 "^DD",9002313.02,9002313.0201,1026,0) PRESCRIBER ALTERNATE ID^F^^A20;6^K:$L(X)>17!($L(X)<1) X "^DD",9002313.02,9002313.0201,1026,3) Answer must be 1-17 characters in length. "^DD",9002313.02,9002313.0201,1026,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,1026,21,1,0) NCPDP Standard field A26-ZP "^DD",9002313.02,9002313.0201,1026,21,2,0) "^DD",9002313.02,9002313.0201,1026,21,3,0) An alternate ID assigned to the prescriber. "^DD",9002313.02,9002313.0201,1026,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,1026,23,1,0) PRESCRIBER SEGMENT "^DD",9002313.02,9002313.0201,1026,"DT") 3130301 "^DD",9002313.02,9002313.0201,1027,0) PRESCRIBER ALTERNATE STATE^F^^A20;7^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,1027,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,1027,21,0) ^^5^5^3130301^ "^DD",9002313.02,9002313.0201,1027,21,1,0) NCPDP Standard field A27-ZQ "^DD",9002313.02,9002313.0201,1027,21,2,0) "^DD",9002313.02,9002313.0201,1027,21,3,0) The postal state code abbreviation that is used in conjunction with the "^DD",9002313.02,9002313.0201,1027,21,4,0) Prescriber Alternate ID Qualifier and the Prescriber Alternate ID fields "^DD",9002313.02,9002313.0201,1027,21,5,0) to identify what state the identification is from. "^DD",9002313.02,9002313.0201,1027,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,1027,23,1,0) PRESCRIBER SEGMENT "^DD",9002313.02,9002313.0201,1027,"DT") 3130301 "^DD",9002313.02,9002313.0201,1029,0) REPORTED ADJUDICATED PROG TYPE^F^^A20;9^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,1029,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,1029,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,1029,21,1,0) NCPDP Standard field A29-ZS "^DD",9002313.02,9002313.0201,1029,21,2,0) "^DD",9002313.02,9002313.0201,1029,21,3,0) The type of prescription benefit plan that adjudicated and paid for the "^DD",9002313.02,9002313.0201,1029,21,4,0) prescription. "^DD",9002313.02,9002313.0201,1029,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,1029,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,1029,"DT") 3210330 "^DD",9002313.02,9002313.0201,1030,0) RELEASED DATE^F^^A20;10^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.0201,1030,3) Answer must be 1-10 characters in length. "^DD",9002313.02,9002313.0201,1030,21,0) ^^4^4^3130301^ "^DD",9002313.02,9002313.0201,1030,21,1,0) NCPDP Standard field A30-ZT "^DD",9002313.02,9002313.0201,1030,21,2,0) "^DD",9002313.02,9002313.0201,1030,21,3,0) Identifies the date the prescription was relinquished from the dispensing "^DD",9002313.02,9002313.0201,1030,21,4,0) facility to the patient or purchaser. "^DD",9002313.02,9002313.0201,1030,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,1030,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,1030,"DT") 3130301 "^DD",9002313.02,9002313.0201,1031,0) RELEASED TIME^F^^A30;1^K:$L(X)>8!($L(X)<1) X "^DD",9002313.02,9002313.0201,1031,3) Answer must be 1-8 characters in length. "^DD",9002313.02,9002313.0201,1031,21,0) ^^5^5^3130301^ "^DD",9002313.02,9002313.0201,1031,21,1,0) NCPDP Standard field A31-ZU "^DD",9002313.02,9002313.0201,1031,21,2,0) "^DD",9002313.02,9002313.0201,1031,21,3,0) Indicates the time the prescription was relinquished from the dispensing "^DD",9002313.02,9002313.0201,1031,21,4,0) facility to the patient or purchaser. This is the local time that "^DD",9002313.02,9002313.0201,1031,21,5,0) corresponds with the Released Date (A3Ø-ZT) "^DD",9002313.02,9002313.0201,1031,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,1031,23,1,0) PURCHASER SEGMENT "^DD",9002313.02,9002313.0201,1031,"DT") 3130301 "^DD",9002313.02,9002313.0201,1032,0) COMPOUND PREPARATION TIME^F^^A30;2^K:$L(X)>6!($L(X)<1) X "^DD",9002313.02,9002313.0201,1032,3) Answer must be 1-6 characters in length. "^DD",9002313.02,9002313.0201,1032,21,0) ^^3^3^3130301^ "^DD",9002313.02,9002313.0201,1032,21,1,0) NCPDP Standard field A32-ZW "^DD",9002313.02,9002313.0201,1032,21,2,0) "^DD",9002313.02,9002313.0201,1032,21,3,0) Measurement in minutes for the preparation of the compound. "^DD",9002313.02,9002313.0201,1032,23,0) ^^1^1^3130222^ "^DD",9002313.02,9002313.0201,1032,23,1,0) COMPOUND SEGMENT "^DD",9002313.02,9002313.0201,1032,"DT") 3130301 "^DD",9002313.02,9002313.0201,1093,0) SERVICE PROVIDER COUNTRY CODE^F^^A90;3^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,1093,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,1093,21,0) ^^2^2^3141231^ "^DD",9002313.02,9002313.0201,1093,21,1,0) This is used to hold NCPDP file A93-IT (Service Provider Country Code), "^DD",9002313.02,9002313.0201,1093,21,2,0) which is defined as "Indicates the country of the provider". "^DD",9002313.02,9002313.0201,1093,"DT") 3141230 "^DD",9002313.02,9002313.0201,2013,0) AUTH REP STREET ADDRESS LINE 1^F^^B11;3^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2013,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2013,21,0) ^^3^3^3141230^ "^DD",9002313.02,9002313.0201,2013,21,1,0) This is used to store NCPDP field B13-7D (Authorized Representative "^DD",9002313.02,9002313.0201,2013,21,2,0) Street Address Line 1), which is defined as "Free-form text for address "^DD",9002313.02,9002313.0201,2013,21,3,0) line 1 information". "^DD",9002313.02,9002313.0201,2013,"DT") 3141230 "^DD",9002313.02,9002313.0201,2014,0) AUTH REP STREET ADDRESS LINE 2^F^^B11;4^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2014,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2014,21,0) ^^3^3^3141230^ "^DD",9002313.02,9002313.0201,2014,21,1,0) This is used to store NCPDP field B14-8B (Authorized Representative "^DD",9002313.02,9002313.0201,2014,21,2,0) Street Address Line 2), which is defined as "Free-form text for address "^DD",9002313.02,9002313.0201,2014,21,3,0) line 2 information". "^DD",9002313.02,9002313.0201,2014,"DT") 3141230 "^DD",9002313.02,9002313.0201,2015,0) EMPLOYER STREET ADDRESS LINE 1^F^^B10;5^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2015,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2015,21,0) ^^2^2^3141223^ "^DD",9002313.02,9002313.0201,2015,21,1,0) This is used to store NCPDP field B15-8D (Employer Street Address Line "^DD",9002313.02,9002313.0201,2015,21,2,0) 1), which is defined as "Free-form text for address line1 information". "^DD",9002313.02,9002313.0201,2015,"DT") 3141223 "^DD",9002313.02,9002313.0201,2016,0) EMPLOYER STREET ADDRESS LINE 2^F^^B10;6^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2016,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2016,21,0) ^^2^2^3141223^ "^DD",9002313.02,9002313.0201,2016,21,1,0) This is used to store NCPDP field B16-7G (Employer Street Address Line "^DD",9002313.02,9002313.0201,2016,21,2,0) 2), which is defined as "Free-form text for address line 2 information". "^DD",9002313.02,9002313.0201,2016,"DT") 3141223 "^DD",9002313.02,9002313.0201,2017,0) EMPLOYER CONTACT FIRST NAME^F^^B10;7^K:$L(X)>37!($L(X)<1) X "^DD",9002313.02,9002313.0201,2017,3) Answer must be 1-37 characters in length. "^DD",9002313.02,9002313.0201,2017,21,0) ^^2^2^3141223^ "^DD",9002313.02,9002313.0201,2017,21,1,0) This is used to store NCPDP field B17-7H (Employer Contact First Name), "^DD",9002313.02,9002313.0201,2017,21,2,0) which is defined as "First name of the employer's primary contact". "^DD",9002313.02,9002313.0201,2017,"DT") 3141223 "^DD",9002313.02,9002313.0201,2018,0) EMPLOYER CONTACT LAST NAME^F^^B10;8^K:$L(X)>37!($L(X)<1) X "^DD",9002313.02,9002313.0201,2018,3) Answer must be 1-37 characters in length. "^DD",9002313.02,9002313.0201,2018,21,0) ^^2^2^3141223^ "^DD",9002313.02,9002313.0201,2018,21,1,0) This is used to store NCPDP field B18-7J (Employer Contact Last Name), "^DD",9002313.02,9002313.0201,2018,21,2,0) which is defined as "Last name of the employer's primary contact". "^DD",9002313.02,9002313.0201,2018,"DT") 3141223 "^DD",9002313.02,9002313.0201,2019,0) EMPLOYER PHONE NUMBER EXT^F^^B10;9^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.0201,2019,3) Answer must be 1-10 characters in length. "^DD",9002313.02,9002313.0201,2019,21,0) ^^2^2^3141223^ "^DD",9002313.02,9002313.0201,2019,21,1,0) This is used to store NCPDP field B19-7K (Employer Telephone Number "^DD",9002313.02,9002313.0201,2019,21,2,0) Extension), which is defined as "Extension of the telephone number". "^DD",9002313.02,9002313.0201,2019,"DT") 3141223 "^DD",9002313.02,9002313.0201,2020,0) FACILITY STREET ADDRESS LINE 1^F^^B11;10^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2020,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2020,21,0) ^^3^3^3141231^ "^DD",9002313.02,9002313.0201,2020,21,1,0) This is used to store NCPDP field B20-7M (Facility Street Address Line 1), "^DD",9002313.02,9002313.0201,2020,21,2,0) which is defined as "Free form text for Facility address line 1 "^DD",9002313.02,9002313.0201,2020,21,3,0) information". "^DD",9002313.02,9002313.0201,2020,"DT") 3141230 "^DD",9002313.02,9002313.0201,2021,0) FACILITY STREET ADDRESS LINE 2^F^^B20;1^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2021,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2021,21,0) ^^3^3^3141231^ "^DD",9002313.02,9002313.0201,2021,21,1,0) This is used to store NCPDP field B21-7N (Facility Street Address Line 2), "^DD",9002313.02,9002313.0201,2021,21,2,0) which is defined as "Free form text for Facility address line 2 "^DD",9002313.02,9002313.0201,2021,21,3,0) information". "^DD",9002313.02,9002313.0201,2021,"DT") 3141230 "^DD",9002313.02,9002313.0201,2024,0) PAY TO STREET ADDRESS LINE 1^F^^B20;4^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2024,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2024,21,0) ^^3^3^3141223^ "^DD",9002313.02,9002313.0201,2024,21,1,0) This is used to store NCPDP field B24-7R (Pay To Street Address Line 1), "^DD",9002313.02,9002313.0201,2024,21,2,0) which is defined as "Line 1 of street address of the entity to receive "^DD",9002313.02,9002313.0201,2024,21,3,0) payment for claim". "^DD",9002313.02,9002313.0201,2024,"DT") 3141223 "^DD",9002313.02,9002313.0201,2025,0) PAY TO STREET ADDRESS LINE 2^F^^B20;5^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2025,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2025,21,0) ^^3^3^3141223^ "^DD",9002313.02,9002313.0201,2025,21,1,0) This is used to store NCPDP field B25-7S (Pay to Street Address Line 2), "^DD",9002313.02,9002313.0201,2025,21,2,0) which is defined as "Line 2 of street address of the entity to receive "^DD",9002313.02,9002313.0201,2025,21,3,0) payment for claim". "^DD",9002313.02,9002313.0201,2025,"DT") 3141223 "^DD",9002313.02,9002313.0201,2026,0) PRESCRIBER PHONE NUMBER EXT^F^^B20;6^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.0201,2026,3) Answer must be 1-10 characters in length. "^DD",9002313.02,9002313.0201,2026,21,0) ^^2^2^3141231^ "^DD",9002313.02,9002313.0201,2026,21,1,0) This is used to store NCPDP field B26-7T (Prescriber Telephone Number "^DD",9002313.02,9002313.0201,2026,21,2,0) Extension), which is defined as "Extension of the telephone number". "^DD",9002313.02,9002313.0201,2026,"DT") 3141223 "^DD",9002313.02,9002313.0201,2027,0) PRESCRIBER STREET ADDR LINE 1^F^^B20;7^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2027,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2027,21,0) ^^3^3^3141231^ "^DD",9002313.02,9002313.0201,2027,21,1,0) This is used to store NCPDP field B27-7U (Prescriber Street Address Line "^DD",9002313.02,9002313.0201,2027,21,2,0) 1), which is defined as "Free form text for prescriber address line 1 "^DD",9002313.02,9002313.0201,2027,21,3,0) information". "^DD",9002313.02,9002313.0201,2027,"DT") 3141223 "^DD",9002313.02,9002313.0201,2028,0) PRESCRIBER STREET ADDR LINE 2^F^^B20;8^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2028,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2028,21,0) ^^3^3^3141223^ "^DD",9002313.02,9002313.0201,2028,21,1,0) This is used to store NCPDP field B28-7V (Prescriber Street Address Line "^DD",9002313.02,9002313.0201,2028,21,2,0) 2), which is defined as "Free form text for prescriber address line 2 "^DD",9002313.02,9002313.0201,2028,21,3,0) information". "^DD",9002313.02,9002313.0201,2028,"DT") 3141223 "^DD",9002313.02,9002313.0201,2029,0) PURCHASER STREET ADDRESS LINE1^F^^B21;9^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2029,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2029,21,0) ^^2^2^3141230^ "^DD",9002313.02,9002313.0201,2029,21,1,0) This is used to store NCPDP field B29-7W (Purchaser Street Address Line "^DD",9002313.02,9002313.0201,2029,21,2,0) 1), which is defined as "Free-form text for address line 1 information". "^DD",9002313.02,9002313.0201,2029,"DT") 3141230 "^DD",9002313.02,9002313.0201,2030,0) PURCHASER STREET ADDRESS LINE2^F^^B21;10^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2030,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2030,21,0) ^^2^2^3141231^ "^DD",9002313.02,9002313.0201,2030,21,1,0) This is used to store NCPDP field B30-7X (Purchaser Street Address Line "^DD",9002313.02,9002313.0201,2030,21,2,0) 2), which is defined as "Free-form text for address line 2 information". "^DD",9002313.02,9002313.0201,2030,"DT") 3141230 "^DD",9002313.02,9002313.0201,2031,0) SERVICE PROV STREET ADD LINE 1^F^^B30;1^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2031,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2031,21,0) ^^3^3^3141230^ "^DD",9002313.02,9002313.0201,2031,21,1,0) This is used to store NCPDP field B31-7Y (Service Provider Street Address "^DD",9002313.02,9002313.0201,2031,21,2,0) Line 1), which is defined as "Line 1 of the street address of the "^DD",9002313.02,9002313.0201,2031,21,3,0) service provider". "^DD",9002313.02,9002313.0201,2031,"DT") 3141230 "^DD",9002313.02,9002313.0201,2032,0) SERVICE PROV STREET ADD LINE 2^F^^B30;2^K:$L(X)>42!($L(X)<1) X "^DD",9002313.02,9002313.0201,2032,3) Answer must be 1-42 characters in length. "^DD",9002313.02,9002313.0201,2032,21,0) ^.001^3^3^3141230^^ "^DD",9002313.02,9002313.0201,2032,21,1,0) This is used to store NCPDP field B32-7Z (Service Provider Street Address "^DD",9002313.02,9002313.0201,2032,21,2,0) Line 2), which is defined as "Line 2 of the street address of the "^DD",9002313.02,9002313.0201,2032,21,3,0) service provider". "^DD",9002313.02,9002313.0201,2032,"DT") 3141230 "^DD",9002313.02,9002313.0201,2034,0) AUTH REP COUNTRY CODE^F^^B30;4^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,2034,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,2034,21,0) ^^2^2^3141230^ "^DD",9002313.02,9002313.0201,2034,21,1,0) This is used to store NCPDP field B34-1U (Authorized Representative "^DD",9002313.02,9002313.0201,2034,21,2,0) Country Code), which is defined as "Indicates the county of the pharmacy". "^DD",9002313.02,9002313.0201,2034,"DT") 3141230 "^DD",9002313.02,9002313.0201,2035,0) EMPLOYER COUNTRY CODE^F^^B30;5^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,2035,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,2035,21,0) ^^2^2^3141231^ "^DD",9002313.02,9002313.0201,2035,21,1,0) This is used to store NCPDP field B35-1V (Employer Country Code), which is "^DD",9002313.02,9002313.0201,2035,21,2,0) defined as "Employer Country Code". "^DD",9002313.02,9002313.0201,2035,"DT") 3141223 "^DD",9002313.02,9002313.0201,2037,0) FACILITY COUNTRY CODE^F^^B30;7^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,2037,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,2037,21,0) ^^2^2^3141230^ "^DD",9002313.02,9002313.0201,2037,21,1,0) This is used to store NCPDP field B37-1X (Facility Country Code), which is "^DD",9002313.02,9002313.0201,2037,21,2,0) defined as "Code of the country". "^DD",9002313.02,9002313.0201,2037,"DT") 3141230 "^DD",9002313.02,9002313.0201,2039,0) PAY TO COUNTRY CODE^F^^B30;9^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,2039,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,2039,21,0) ^^2^2^3141223^ "^DD",9002313.02,9002313.0201,2039,21,1,0) This is used to store NCPDP field B39-1Z (Pay to Country Code), which is "^DD",9002313.02,9002313.0201,2039,21,2,0) defined as "Code of the country". "^DD",9002313.02,9002313.0201,2039,"DT") 3141223 "^DD",9002313.02,9002313.0201,2040,0) PRES ALT ID ASSOC COUNTRY CODE^F^^B30;10^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,2040,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,2040,21,0) ^.001^2^2^3141231^^ "^DD",9002313.02,9002313.0201,2040,21,1,0) This is used to store NCPDP field B40-3A (Prescriber Alternate ID "^DD",9002313.02,9002313.0201,2040,21,2,0) Associated Country Code), which is defined as "Code of the country". "^DD",9002313.02,9002313.0201,2040,"DT") 3141231 "^DD",9002313.02,9002313.0201,2041,0) PRES ID ASSOC COUNTRY CODE^F^^B40;1^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,2041,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,2041,21,0) ^^2^2^3141231^ "^DD",9002313.02,9002313.0201,2041,21,1,0) This is used to store NCPDP field B41-3B (Prescriber ID Associated Country "^DD",9002313.02,9002313.0201,2041,21,2,0) Code), which is defined as "Code of the country". "^DD",9002313.02,9002313.0201,2041,"DT") 3141223 "^DD",9002313.02,9002313.0201,2042,0) PRESCRIBER COUNTRY CODE^F^^B40;2^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,2042,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,2042,21,0) ^^2^2^3141231^ "^DD",9002313.02,9002313.0201,2042,21,1,0) This is used to store NCPDP field B42-3C (Prescriber Country Code), which "^DD",9002313.02,9002313.0201,2042,21,2,0) is defined as "Code of the country". "^DD",9002313.02,9002313.0201,2042,"DT") 3141223 "^DD",9002313.02,9002313.0201,2043,0) PURCHASER ID ASSOC COUNTRY CD^F^^B40;3^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,2043,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,2043,21,0) ^^2^2^3141230^ "^DD",9002313.02,9002313.0201,2043,21,1,0) This is used to store NCPDP field B43-3D (Purchaser ID Associated Country "^DD",9002313.02,9002313.0201,2043,21,2,0) Code), which is defined as "Code of the country". "^DD",9002313.02,9002313.0201,2043,"DT") 3141230 "^DD",9002313.02,9002313.0201,2044,0) INTERMEDIARY ID COUNT^F^^B40;4^K:$L(X)>3!($L(X)<1) X "^DD",9002313.02,9002313.0201,2044,3) Answer must be 1-3 characters in length. "^DD",9002313.02,9002313.0201,2044,21,0) ^^6^6^3141231^ "^DD",9002313.02,9002313.0201,2044,21,1,0) This is used to store NCPDP field B44-8G (Intermediary ID Count), which "^DD",9002313.02,9002313.0201,2044,21,2,0) is defined as "Count of Intermediary ID Type Code (B45-8H), "^DD",9002313.02,9002313.0201,2044,21,3,0) Intermediary Type Entity (B46-8J), Intermediary ID Qualifier (B47-8K), "^DD",9002313.02,9002313.0201,2044,21,4,0) Intermediary ID (B48-8M), Intermediary ID State/Province Address "^DD",9002313.02,9002313.0201,2044,21,5,0) (B49-8N) and Intermediary ID Relationship Code (B50-8P) occurrence". "^DD",9002313.02,9002313.0201,2044,21,6,0) These other NCPDP fields are stored in the Intermediary ID multiple. "^DD",9002313.02,9002313.0201,2044,"DT") 3141231 "^DD",9002313.02,9002313.0201,2044.01,0) INTERMEDIARY ID MULTIPLE^9002313.022044^^B44;0 "^DD",9002313.02,9002313.0201,2044.01,21,0) ^.001^2^2^3141231^^^ "^DD",9002313.02,9002313.0201,2044.01,21,1,0) This multiple is used to hold the NCPDP values for the Intermediary ID "^DD",9002313.02,9002313.0201,2044.01,21,2,0) repeating group. "^DD",9002313.02,9002313.0201,2056,0) LAST KNOWN IIN NUMBER^F^^B50;6^K:$L(X)>8!($L(X)<1) X "^DD",9002313.02,9002313.0201,2056,3) Answer must be 1-8 characters in length. "^DD",9002313.02,9002313.0201,2056,21,0) ^^3^3^3210429^ "^DD",9002313.02,9002313.0201,2056,21,1,0) This is used to store NCPDP field B56-3E (Last Known IIN Number), which is "^DD",9002313.02,9002313.0201,2056,21,2,0) defined as "Last known Card Issuer ID or Bank ID Number used for network "^DD",9002313.02,9002313.0201,2056,21,3,0) routing used on a previous claim". "^DD",9002313.02,9002313.0201,2056,"DT") 3210429 "^DD",9002313.02,9002313.0201,2057,0) LAST KNOWN PROCESSOR CNTRL NUM^F^^B50;7^K:$L(X)>12!($L(X)<1) X "^DD",9002313.02,9002313.0201,2057,3) Answer must be 1-12 characters in length. "^DD",9002313.02,9002313.0201,2057,21,0) ^.001^3^3^3141230^^ "^DD",9002313.02,9002313.0201,2057,21,1,0) This is used to store NCPDP field B57-3F (Last Known Processor Control "^DD",9002313.02,9002313.0201,2057,21,2,0) Number), which is defined as "Last known number assigned by the processor "^DD",9002313.02,9002313.0201,2057,21,3,0) used on a previous claim". "^DD",9002313.02,9002313.0201,2057,"DT") 3141230 "^DD",9002313.02,9002313.0201,2058,0) LAST KNOWN GROUP ID^F^^B50;8^K:$L(X)>17!($L(X)<1) X "^DD",9002313.02,9002313.0201,2058,3) Answer must be 1-17 characters in length. "^DD",9002313.02,9002313.0201,2058,21,0) ^^3^3^3141230^ "^DD",9002313.02,9002313.0201,2058,21,1,0) This is used to store NCPDP field B58-3G (Last Known Group ID), which is "^DD",9002313.02,9002313.0201,2058,21,2,0) defined as "Last known ID assigned to the cardholder group or employer "^DD",9002313.02,9002313.0201,2058,21,3,0) group used on a previous claim". "^DD",9002313.02,9002313.0201,2058,"DT") 3141230 "^DD",9002313.02,9002313.0201,2059,0) LAST KNOWN CARDHOLDER ID^F^^B50;9^K:$L(X)>22!($L(X)<1) X "^DD",9002313.02,9002313.0201,2059,3) Answer must be 1-22 characters in length. "^DD",9002313.02,9002313.0201,2059,21,0) ^^3^3^3141230^ "^DD",9002313.02,9002313.0201,2059,21,1,0) This is used to store NCPDP field B59-3H (Last Known Cardholder ID), "^DD",9002313.02,9002313.0201,2059,21,2,0) which is defined as "Last known insurance ID assigned to the cardholder "^DD",9002313.02,9002313.0201,2059,21,3,0) or identification number used by the plan used on a previous claim". "^DD",9002313.02,9002313.0201,2059,"DT") 3141230 "^DD",9002313.02,9002313.0201,2060,0) YEAR OF LAST PAID CLAIM^F^^B50;10^K:$L(X)>6!($L(X)<1) X "^DD",9002313.02,9002313.0201,2060,3) Answer must be 1-6 characters in length. "^DD",9002313.02,9002313.0201,2060,21,0) ^^2^2^3141231^ "^DD",9002313.02,9002313.0201,2060,21,1,0) This is used to store NCPDP field B60-3J (Year of Last Paid Claim), which "^DD",9002313.02,9002313.0201,2060,21,2,0) is defined as "Identifies the year used on a previous claim". "^DD",9002313.02,9002313.0201,2060,"DT") 3141231 "^DD",9002313.02,9002313.0201,2061,0) MONTH OF LAST PAID CLAIM^F^^B60;1^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0201,2061,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.0201,2061,21,0) ^^2^2^3141231^ "^DD",9002313.02,9002313.0201,2061,21,1,0) This is used to store NCPDP field B61-3K (Month of Last Paid Claim), "^DD",9002313.02,9002313.0201,2061,21,2,0) which is defined as "Identifies the month used on a previous claim". "^DD",9002313.02,9002313.0201,2061,"DT") 3141231 "^DD",9002313.02,9002313.0201,2095,0) FACILITY ID QUALIFIER^FJ2^^B90;5^K:$L(X)>2!($L(X)<1) X "^DD",9002313.02,9002313.0201,2095,3) Answer must be 1-2 characters in length. "^DD",9002313.02,9002313.0201,2095,21,0) ^^2^2^3170530^ "^DD",9002313.02,9002313.0201,2095,21,1,0) Code qualifying the 'Facility ID' (336-8C). NCPDP standard field B95-3Z. "^DD",9002313.02,9002313.0201,2095,21,2,0) Blank=Not Specified, 1=Facility Type 2 NPI, 2= Other "^DD",9002313.02,9002313.0201,2095,"DT") 3170530 "^DD",9002313.02,9002313.0201,2096,0) PROVIDER FIRST NAME^FJ35^^B90;6^K:$L(X)>35!($L(X)<1) X "^DD",9002313.02,9002313.0201,2096,3) Enter a first name 1-35 characters in length. "^DD",9002313.02,9002313.0201,2096,21,0) ^^2^2^3170228^ "^DD",9002313.02,9002313.0201,2096,21,1,0) The First Name of the provider of the product/service. "^DD",9002313.02,9002313.0201,2096,21,2,0) NCPDP standard field B96-4A. "^DD",9002313.02,9002313.0201,2096,23,0) ^^1^1^3170228^ "^DD",9002313.02,9002313.0201,2096,23,1,0) PHARMACY PROVIDER SEGMENT "^DD",9002313.02,9002313.0201,2096,"DT") 3170301 "^DD",9002313.02,9002313.0201,2097,0) PROVIDER LAST NAME^FJ35^^B90;7^K:$L(X)>35!($L(X)<1) X "^DD",9002313.02,9002313.0201,2097,3) Enter a last name 1-35 characters in length. "^DD",9002313.02,9002313.0201,2097,21,0) ^^2^2^3170228^ "^DD",9002313.02,9002313.0201,2097,21,1,0) The Last Name of the provider of the product/service. "^DD",9002313.02,9002313.0201,2097,21,2,0) NCPDP standard field B97-4M. "^DD",9002313.02,9002313.0201,2097,23,0) ^^1^1^3170228^ "^DD",9002313.02,9002313.0201,2097,23,1,0) PHARMACY PROVIDER SEGMENT "^DD",9002313.02,9002313.0201,2097,"DT") 3170301 "^DD",9002313.02,9002313.0201,2101,0) ORIG MANUFACTURER PRODUCT ID^FJ19^^C00;1^K:$L(X)>19!($L(X)<1) X "^DD",9002313.02,9002313.0201,2101,3) Enter a value 1-19 characters in length. "^DD",9002313.02,9002313.0201,2101,21,0) ^^2^2^3170228^ "^DD",9002313.02,9002313.0201,2101,21,1,0) ID assigned to the original manufacturer of the product. "^DD",9002313.02,9002313.0201,2101,21,2,0) NCPDP standard field C01-4N. "^DD",9002313.02,9002313.0201,2101,23,0) ^^1^1^3170228^ "^DD",9002313.02,9002313.0201,2101,23,1,0) CLAIM SEGMENT "^DD",9002313.02,9002313.0201,2101,"DT") 3170301 "^DD",9002313.02,9002313.0201,2102,0) ORIG MANUFACTURER PROD ID QUAL^S^3:NDC-Nation Drug code;^C00;2^Q "^DD",9002313.02,9002313.0201,2102,3) Enter '3' or leave blank if the Product ID is empty. "^DD",9002313.02,9002313.0201,2102,21,0) ^^2^2^3170301^ "^DD",9002313.02,9002313.0201,2102,21,1,0) Qualifies Original Manufacturer Product ID C01-4N. "^DD",9002313.02,9002313.0201,2102,21,2,0) NCPDP standard field C02-4P. "^DD",9002313.02,9002313.0201,2102,23,0) ^^1^1^3170228^ "^DD",9002313.02,9002313.0201,2102,23,1,0) CLAIM SEGMENT "^DD",9002313.02,9002313.0201,2102,"DT") 3170301 "^DD",9002313.02,9002313.0201,2147,0) OTHER PAYER PROGRAM TYPE^P9002313.38'^BPS(9002313.38,^C40;7^Q "^DD",9002313.02,9002313.0201,2147,3) Enter the value of the Other Payer Adjudicated Program Type. "^DD",9002313.02,9002313.0201,2147,21,0) ^^2^2^3180510^ "^DD",9002313.02,9002313.0201,2147,21,1,0) The type of prescription benefit plan/program associated with the Other "^DD",9002313.02,9002313.0201,2147,21,2,0) Payer. "^DD",9002313.02,9002313.0201,2147,"DT") 3180521 "^DD",9002313.02,9002313.0201,2149,0) OTHER PAYER RECONCILIATION ID^FJ30^^C40;9^K:$L(X)>30!($L(X)<1) X "^DD",9002313.02,9002313.0201,2149,3) Enter the Other Payer Reconciliation ID, 1 to 10 characters in length. "^DD",9002313.02,9002313.0201,2149,21,0) ^^5^5^3180522^ "^DD",9002313.02,9002313.0201,2149,21,1,0) Reconciliation ID (B98-34) as reported by the Other Payer for "^DD",9002313.02,9002313.0201,2149,21,2,0) Paid/Accepted transactions OR for Information Reporting transactions, the "^DD",9002313.02,9002313.0201,2149,21,3,0) designated default value for reporting a previous payer's rejected "^DD",9002313.02,9002313.0201,2149,21,4,0) response as designated in the Other Payer Reject Code value(s) reported "^DD",9002313.02,9002313.0201,2149,21,5,0) in the COB claim. "^DD",9002313.02,9002313.0201,2149,"DT") 3180716 "^DD",9002313.02,9002313.0201,2150,0) BENEFIT STAGE INDICATOR COUNT^NJ1,0^^C40;10^K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X "^DD",9002313.02,9002313.0201,2150,3) Type a number between 0 and 9, 0 decimal digits. "^DD",9002313.02,9002313.0201,2150,21,0) ^^1^1^3180510^ "^DD",9002313.02,9002313.0201,2150,21,1,0) Count of Benefit Stage Indicator (C51-9X) occurrences. "^DD",9002313.02,9002313.0201,2150,"DT") 3180521 "^DD",9002313.02,9002313.0201,2151,0) BENEFIT STAGE INDICATOR^P9002313.35'^BPS(9002313.35,^C50;1^Q "^DD",9002313.02,9002313.0201,2151,3) Enter a Benefit Stage Indicator. "^DD",9002313.02,9002313.0201,2151,21,0) ^^2^2^3180510^ "^DD",9002313.02,9002313.0201,2151,21,1,0) Code identifying the Benefit Stage(s) which applied to the claim at the "^DD",9002313.02,9002313.0201,2151,21,2,0) time of adjudication. "^DD",9002313.02,9002313.0201,2151,"DT") 3180514 "^DD",9002313.02,9002313.0201,2160,0) COMPOUND LEVEL OF COMPLEXITY^S^1:LOW LEVEL COMPLEXITY;10:MID-LEVEL COMP NON-HAZARDOUS;20:MID-LEVEL COMP HAZARDOUS;31:HIGH LEVEL NON-HAZARDOUS STERILE;41:HIGH LEVEL HAZARDOUS STERILE;51:HIGH LEVEL NON-HAZARDOUS;61:HIGH LEVEL HAZARDOUS;^C50;10^Q "^DD",9002313.02,9002313.0201,2160,3) Select a value used by the pharmacy to indicate the complexity involved in the preparation of the compounded prescription. "^DD",9002313.02,9002313.0201,2160,21,0) ^^2^2^3200723^ "^DD",9002313.02,9002313.0201,2160,21,1,0) This is the value used by the pharmacy to indicate the complexity "^DD",9002313.02,9002313.0201,2160,21,2,0) involved in the preparation of the compounded prescription. "^DD",9002313.02,9002313.0201,2160,"DT") 3200723 "^DD",9002313.02,9002313.0201,2190,0) LTPAC BILLING METHODOLOGY^S^1:FULL QUANTITY;2:POST-CONSUMPTION;3:PRE-CONSUMPTION;^C80;10^Q "^DD",9002313.02,9002313.0201,2190,3) Enter billing methodology 1, 2 or 3. "^DD",9002313.02,9002313.0201,2190,21,0) ^^1^1^3180510^ "^DD",9002313.02,9002313.0201,2190,21,1,0) Code indicating the billing methodology used for the claim. "^DD",9002313.02,9002313.0201,2190,"DT") 3180521 "^DD",9002313.02,9002313.0201,2191,0) LTPAC DISPENSE FREQUENCY^P9002313.36'^BPS(9002313.36,^C90;1^Q "^DD",9002313.02,9002313.0201,2191,3) Enter a LTPAC Dispense Frequency code. "^DD",9002313.02,9002313.0201,2191,21,0) ^^1^1^3180510^ "^DD",9002313.02,9002313.0201,2191,21,1,0) Code indicating the frequency of dispensing medication to a LTPAC patient. "^DD",9002313.02,9002313.0201,2191,"DT") 3180515 "^DD",9002313.02,9002313.0201,2192,0) NUMBER LTPAC DISPENSING EVENTS^NJ3,0^^C90;2^K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X "^DD",9002313.02,9002313.0201,2192,.1) NUMBER OF LTPAC DISPENSING EVENTS "^DD",9002313.02,9002313.0201,2192,3) Enter a number between 0 and 999, 0 decimal digits. "^DD",9002313.02,9002313.0201,2192,21,0) ^^2^2^3180510^ "^DD",9002313.02,9002313.0201,2192,21,1,0) Value indicating the number of times pharmacy dispensed product or "^DD",9002313.02,9002313.0201,2192,21,2,0) service for the claim period requested. "^DD",9002313.02,9002313.0201,2192,"DT") 3210330 "^DD",9002313.02,9002313.0201,2198,0) PREPARATION ENVIRONMENT CODE^S^1:PILL SPLITTING;2:OTHER;^C90;8^Q "^DD",9002313.02,9002313.0201,2198,3) Enter a preparation environment code. "^DD",9002313.02,9002313.0201,2198,21,0) ^^1^1^3180510^ "^DD",9002313.02,9002313.0201,2198,21,1,0) Event which required a special preparation environment. "^DD",9002313.02,9002313.0201,2198,"DT") 3180716 "^DD",9002313.02,9002313.0201,2199,0) PREPARATION ENVIRONMENT TYPE^S^1:SPECIFIC PRESSURE ENV NOT REQ/NOT USED;2:POSITIVE PRESSURE NON-STERILE/NON-HAZARDOUS;3:NEGATIVE PRESSURE NON-STERILE/HAZARDOUS;4:POSITIVE PRESSURE STERILE/NON-HAZARDOUS;5:NEGATIVE PRESSURE STERILE/HAZARDOUS;^C90;9^Q "^DD",9002313.02,9002313.0201,2199,3) Enter the code identifying the environment in which the medication was prepared. "^DD",9002313.02,9002313.0201,2199,21,0) ^^1^1^3180510^ "^DD",9002313.02,9002313.0201,2199,21,1,0) Code identifying the environment in which the medication was prepared. "^DD",9002313.02,9002313.0201,2199,"DT") 3180716 "^DD",9002313.02,9002313.0201,2201,0) PRESCRIBER DEA NUMBER^FJ15^^D00;1^K:$L(X)>15!($L(X)<15) X "^DD",9002313.02,9002313.0201,2201,3) Answer must be 15 characters in length. "^DD",9002313.02,9002313.0201,2201,21,0) ^^5^5^3180510^ "^DD",9002313.02,9002313.0201,2201,21,1,0) ID assigned to a health care provider (e.g. Practitioner, Hospital, "^DD",9002313.02,9002313.0201,2201,21,2,0) Manufacturer, etc.) by the US Drug Enforcement Administration, allowing "^DD",9002313.02,9002313.0201,2201,21,3,0) them to distribute, dispense, administer, or conduct research with "^DD",9002313.02,9002313.0201,2201,21,4,0) respect to controlled substances in the course of professional practice "^DD",9002313.02,9002313.0201,2201,21,5,0) or research. "^DD",9002313.02,9002313.0201,2201,"DT") 3180524 "^DD",9002313.02,9002313.0201,2202,0) TOTAL PRESCRIBED QTY REMAINING^NJ10,0^^D00;2^K:+X'=X!(X>9999999999)!(X<1)!(X?.E1"."1.N) X "^DD",9002313.02,9002313.0201,2202,3) Enter a value between 1 and 9999999999, 0 decimal digits. "^DD",9002313.02,9002313.0201,2202,21,0) ^^4^4^3180510^ "^DD",9002313.02,9002313.0201,2202,21,1,0) Accumulated Total Prescribed Quantity Remaining as of the date of "^DD",9002313.02,9002313.0201,2202,21,2,0) service. Calculated value based on: (Prescribed Quantity (460-ET)) * "^DD",9002313.02,9002313.0201,2202,21,3,0) (Number Of Refills Authorized (415-DF) + 1) - Accumulated Quantity "^DD",9002313.02,9002313.0201,2202,21,4,0) Dispensed (442-E7) for each previous fill. "^DD",9002313.02,9002313.0201,2202,"DT") 3210330 "^DD",9002313.02,9002313.0201,2214,0) SUBROGATION AMOUNT REQUESTED^NJ11,2^^D10;4^S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<1)!(X?.E1"."3.N) X "^DD",9002313.02,9002313.0201,2214,3) Enter a dollar amount between 1 and 99999999, 2 decimal digits. "^DD",9002313.02,9002313.0201,2214,21,0) ^^1^1^3180510^ "^DD",9002313.02,9002313.0201,2214,21,1,0) Amount paid by the plan to the pharmacy. "^DD",9002313.02,9002313.0201,2214,"DT") 3180521 "^DD",9002313.02,9002313.0201,2216,0) SUBMISSION TYPE CODE COUNT^NJ1,0^^D10;6^K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X "^DD",9002313.02,9002313.0201,2216,3) Enter a count between 0 and 9, 0 decimal digits. "^DD",9002313.02,9002313.0201,2216,21,0) ^^1^1^3180510^ "^DD",9002313.02,9002313.0201,2216,21,1,0) Count of the Submission Type Code (D17-K8) occurrences. "^DD",9002313.02,9002313.0201,2216,"DT") 3180510 "^DD",9002313.02,9002313.0201,2217,0) SUBMISSION TYPE CODE^S^AA:340B;AB:SPLIT BILLING;AC:ENCOUNTER;AD:NOMINAL PRICE;AE:FEDERAL SUPPLY SCHEDULE;AF:SYNCHRONIZATION FILL;AG:TRIAL FILL - SHORTENED DAYS SUPPLY;^D10;7^Q "^DD",9002313.02,9002313.0201,2217,3) Enter a code identifying the type of submission. "^DD",9002313.02,9002313.0201,2217,21,0) ^^2^2^3200602^ "^DD",9002313.02,9002313.0201,2217,21,1,0) Code identifying the type of submission as needed for appropriate "^DD",9002313.02,9002313.0201,2217,21,2,0) transaction processing. NCPDP Field D17-K8. "^DD",9002313.02,9002313.0201,2217,"DT") 3200602 "^DD",9002313.02,9002313.0201,2218,0) DO NOT DISPENSE BEFORE DATE^D^^D10;8^S %DT="EX" D ^%DT S X=Y K:X<1 X "^DD",9002313.02,9002313.0201,2218,3) Enter the earliest date the drug can be dispensed. "^DD",9002313.02,9002313.0201,2218,21,0) ^^2^2^3180510^ "^DD",9002313.02,9002313.0201,2218,21,1,0) The earliest date the prescriber indicates a prescribed drug can be "^DD",9002313.02,9002313.0201,2218,21,2,0) dispensed. "^DD",9002313.02,9002313.0201,2218,"DT") 3180716 "^DD",9002313.02,9002313.0201,2221,0) MULTIPLE RX/SVC GROUP ID^FJ35^^D20;1^K:$L(X)>35!($L(X)<1) X "^DD",9002313.02,9002313.0201,2221,3) Enter a ID, must be 1-35 characters in length. "^DD",9002313.02,9002313.0201,2221,21,0) ^^2^2^3180510^ "^DD",9002313.02,9002313.0201,2221,21,1,0) Unique ID assigned by the prescriber or pharmacy system to link multiple "^DD",9002313.02,9002313.0201,2221,21,2,0) product orders together. "^DD",9002313.02,9002313.0201,2221,"DT") 3180521 "^DD",9002313.02,9002313.0201,2222,0) MULT RX/SVC GROUP REASON CODE^S^1:INJECTABLE THERAPY;2:LOADING QTY;3:MAINTENANCE QTY;4:UNBREAKABLE PKG MUTL LOCATIONS;5:TRIAL FILL;6:NON-COMM AVAILABLE DOSE;7:BUNDLED HEALTH CARE SERVICE;^D20;2^Q "^DD",9002313.02,9002313.0201,2222,3) Enter the reason of the grouped prescriptions code from 1-7. "^DD",9002313.02,9002313.0201,2222,21,0) ^^2^2^3180510^ "^DD",9002313.02,9002313.0201,2222,21,1,0) Indicates the reason for the quantity dispensed and/or days supply as a "^DD",9002313.02,9002313.0201,2222,21,2,0) result of the prescriber issuing grouped prescriptions. "^DD",9002313.02,9002313.0201,2222,"DT") 3210330 "^DD",9002313.02,9002313.0201,2251,0) OTHER PAYR TAX EXEMPT INDICATR^S^1:OTHER PAYER/PLAN IS TAX EXEMPT;2:OTHER PAYER RELIGIOUS ORGANIZATION;3:OTHER PAYER TAX EXEMPT CERTIFICATE;^D50;1^Q "^DD",9002313.02,9002313.0201,2251,3) Enter a code indicating the source of the tax-exempt status. "^DD",9002313.02,9002313.0201,2251,21,0) ^^2^2^3180521^^ "^DD",9002313.02,9002313.0201,2251,21,1,0) Code indicating the source of the percentage tax exempt status of the "^DD",9002313.02,9002313.0201,2251,21,2,0) other payer's claim. "^DD",9002313.02,9002313.0201,2251,"DT") 3210331 "^DD",9002313.02,9002313.0201,2252,0) OTHER PAYR FEE EXMPT INDICATR^S^1:OTHER PAYER/PLAN IS REG FEE EXEMPT;2:OTHER PAYER RELIGIOUS ORGANIZATION;3:OTHER PAYER REG FEE EXEMPT CERTIFICATE;^D50;2^Q "^DD",9002313.02,9002313.0201,2252,3) Enter a code indicating the source of the regulatory fee exempt status. "^DD",9002313.02,9002313.0201,2252,21,0) ^^2^2^3180511^ "^DD",9002313.02,9002313.0201,2252,21,1,0) Code Indicating the source of the regulatory fee exempt status of the "^DD",9002313.02,9002313.0201,2252,21,2,0) other payer's claim. "^DD",9002313.02,9002313.0201,2252,"DT") 3180716 "^DD",9002313.02,9002313.0201,2253,0) OTHER PAYR FEE TYPE COUNT^NJ1,0^^D50;3^K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X "^DD",9002313.02,9002313.0201,2253,3) Enter a count between 0 and 9, 0 decimal digits. "^DD",9002313.02,9002313.0201,2253,21,0) ^^1^1^3180511^ "^DD",9002313.02,9002313.0201,2253,21,1,0) Count of Other Payer Regulatory Fee Type Code. "^DD",9002313.02,9002313.0201,2253,"DT") 3180521 "^DD",9002313.02,9002313.0201,2257,0) PRESCRIBER PLACE OF SERVICE^P9002313.34'^BPS(9002313.34,^D50;7^Q "^DD",9002313.02,9002313.0201,2257,3) Enter a two digit code between 01 and 99. "^DD",9002313.02,9002313.0201,2257,21,0) ^^2^2^3180511^ "^DD",9002313.02,9002313.0201,2257,21,1,0) Code identifying the place where the patient encounter occurred as "^DD",9002313.02,9002313.0201,2257,21,2,0) reported by the prescriber. "^DD",9002313.02,9002313.0201,2257,"DT") 3180514 "^DD",9002313.02,9002313.0201,2260,0) REGULATORY FEE COUNT^NJ1,0^^D50;10^K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X "^DD",9002313.02,9002313.0201,2260,3) Enter a count between 0 and 9, 0 decimal digits. "^DD",9002313.02,9002313.0201,2260,21,0) ^^1^1^3180511^ "^DD",9002313.02,9002313.0201,2260,21,1,0) Count of Regulatory Fee Type Code (D61-RL). "^DD",9002313.02,9002313.0201,2260,"DT") 3180511 "^DD",9002313.02,9002313.0201,2261,0) REGULATORY FEE TYPE CODE^S^AA:LA RS 46 2625;AB:OTHER;^D60;1^Q "^DD",9002313.02,9002313.0201,2261,3) Enter the code identifying the regulatory fee type. "^DD",9002313.02,9002313.0201,2261,21,0) ^^1^1^3180521^^ "^DD",9002313.02,9002313.0201,2261,21,1,0) Code identifying the type of regulatory fee. "^DD",9002313.02,9002313.0201,2261,"DT") 3180716 "^DD",9002313.02,9002313.0201,2263,0) OTHER PAYER FEE TYPE CODE^S^AA:LA RS 46 2625;AB:OTHER;^D60;3^Q "^DD",9002313.02,9002313.0201,2263,3) Enter the code identifying the other payer fee type. "^DD",9002313.02,9002313.0201,2263,21,0) ^^1^1^3180511^ "^DD",9002313.02,9002313.0201,2263,21,1,0) Code identifying the type of Regulatory Fee reported by the other payer. "^DD",9002313.02,9002313.0201,2263,"DT") 3180716 "^DD",9002313.02,9002313.0201,2312,0) PRESCRIBER MIDDLE NAME^FJ25^^E10;2^K:$L(X)>25!($L(X)<1) X "^DD",9002313.02,9002313.0201,2312,3) Answer must be 1-25 characters in length. "^DD",9002313.02,9002313.0201,2312,21,0) ^^1^1^3191008^ "^DD",9002313.02,9002313.0201,2312,21,1,0) Prescriber middle name. NCPDP standard field E12-0F. "^DD",9002313.02,9002313.0201,2312,"DT") 3191008 "^DD",9002313.02,9002313.0201,2432,0) SEX ASSIGNED AT BIRTH^S^0:UNKNOWN;1:MALE;2:FEMALE;4:INTERSEX;^F30;2^Q "^DD",9002313.02,9002313.0201,2432,3) Select the sex that was assigned at birth. "^DD",9002313.02,9002313.0201,2432,21,0) ^.001^3^3^3220127^^ "^DD",9002313.02,9002313.0201,2432,21,1,0) This field contains one of four values to indicate the patient's sex "^DD",9002313.02,9002313.0201,2432,21,2,0) assigned at birth. Possible value: "^DD",9002313.02,9002313.0201,2432,21,3,0) 0 - UNKNOWN, 1 - MALE, 2 - FEMALE, 4 - INTERSEX "^DD",9002313.02,9002313.0201,2432,23,0) ^.001^1^1^3220127^^ "^DD",9002313.02,9002313.0201,2432,23,1,0) NCPDP standard field F32-W8. "^DD",9002313.02,9002313.0201,2432,"DT") 3220127 "^DD",9002313.02,9002313.022044,0) INTERMEDIARY ID MULTIPLE SUB-FIELD^^2050^8 "^DD",9002313.02,9002313.022044,0,"DT") 3141231 "^DD",9002313.02,9002313.022044,0,"IX","B",9002313.022044,.01) "^DD",9002313.02,9002313.022044,0,"NM","INTERMEDIARY ID MULTIPLE") "^DD",9002313.02,9002313.022044,0,"UP") 9002313.0201 "^DD",9002313.02,9002313.022044,.01,0) INTERMEDIARY ID COUNTER^MNJ2,0^^0;1^K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X "^DD",9002313.02,9002313.022044,.01,1,0) ^.1 "^DD",9002313.02,9002313.022044,.01,1,1,0) 9002313.022044^B "^DD",9002313.02,9002313.022044,.01,1,1,1) S ^BPSC(DA(2),400,DA(1),"B44","B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.022044,.01,1,1,2) K ^BPSC(DA(2),400,DA(1),"B44","B",$E(X,1,30),DA) "^DD",9002313.02,9002313.022044,.01,3) Type a number between 1 and 99, 0 decimal digits. "^DD",9002313.02,9002313.022044,.01,21,0) ^^1^1^3141231^ "^DD",9002313.02,9002313.022044,.01,21,1,0) This is a sequential counter of Intermediary ID occurrences. "^DD",9002313.02,9002313.022044,.01,"DT") 3141231 "^DD",9002313.02,9002313.022044,2045,0) INTERMEDIARY ID TYPE CODE^F^^0;2^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.022044,2045,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.022044,2045,21,0) ^^3^3^3141231^ "^DD",9002313.02,9002313.022044,2045,21,1,0) This is used to store NCPDP field B45-8H (Intermediary ID Type Code), "^DD",9002313.02,9002313.022044,2045,21,2,0) which is defined as "Code identifying the type of Intermediary ID "^DD",9002313.02,9002313.022044,2045,21,3,0) (B48-8M)". "^DD",9002313.02,9002313.022044,2045,"DT") 3141231 "^DD",9002313.02,9002313.022044,2046,0) INTERMEDIARY ID TYPE ENTITY^F^^0;3^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.022044,2046,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.022044,2046,21,0) ^^3^3^3141231^ "^DD",9002313.02,9002313.022044,2046,21,1,0) This is used to store NCPDP field B46-8J (Intermediary ID Type Entity), "^DD",9002313.02,9002313.022044,2046,21,2,0) which is defined as "Code Identifying the type of entity associated "^DD",9002313.02,9002313.022044,2046,21,3,0) with the Intermediary ID (B48-8M)". "^DD",9002313.02,9002313.022044,2046,"DT") 3141231 "^DD",9002313.02,9002313.022044,2047,0) INTERMEDIARY ID QUALIFIER^F^^0;4^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.022044,2047,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.022044,2047,21,0) ^^2^2^3141231^ "^DD",9002313.02,9002313.022044,2047,21,1,0) This is used to store NCPDP field B47-8K (Intermediary ID Qualifier), "^DD",9002313.02,9002313.022044,2047,21,2,0) which is defined as "Code qualifying the 'Intermediary ID' (B48-8M)". "^DD",9002313.02,9002313.022044,2047,"DT") 3141231 "^DD",9002313.02,9002313.022044,2048,0) INTERMEDIARY ID^F^^0;5^K:$L(X)>22!($L(X)<1) X "^DD",9002313.02,9002313.022044,2048,3) Answer must be 1-22 characters in length. "^DD",9002313.02,9002313.022044,2048,21,0) ^^2^2^3141231^ "^DD",9002313.02,9002313.022044,2048,21,1,0) This is used to store NCPDP field B48-8M (Intermediary ID), which is "^DD",9002313.02,9002313.022044,2048,21,2,0) defined as "Intermediary ID assigned to the type entity". "^DD",9002313.02,9002313.022044,2048,"DT") 3141231 "^DD",9002313.02,9002313.022044,2049,0) INTERMEDIARY ID STATE/PROV ADD^F^^0;6^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.022044,2049,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.022044,2049,21,0) ^^5^5^3141231^ "^DD",9002313.02,9002313.022044,2049,21,1,0) This is used to store NCPDP field B49-8N (Intermediary ID State/Province "^DD",9002313.02,9002313.022044,2049,21,2,0) Address), which is defined as "The postal state code abbreviation that "^DD",9002313.02,9002313.022044,2049,21,3,0) is used in conjunction with the Intermediary ID Qualifier and the "^DD",9002313.02,9002313.022044,2049,21,4,0) Intermediary ID fields to identify what state the identification is "^DD",9002313.02,9002313.022044,2049,21,5,0) from". "^DD",9002313.02,9002313.022044,2049,"DT") 3141231 "^DD",9002313.02,9002313.022044,2050,0) INTERMEDIARY ID RELATION CODE^F^^0;8^K:$L(X)>3!($L(X)<1) X "^DD",9002313.02,9002313.022044,2050,3) Answer must be 1-3 characters in length. "^DD",9002313.02,9002313.022044,2050,21,0) ^^3^3^3141231^ "^DD",9002313.02,9002313.022044,2050,21,1,0) This is used to store NCPDP field B50-8P (Intermediary ID Relationship "^DD",9002313.02,9002313.022044,2050,21,2,0) Code), which is defined as "Code indicating the relationship to the "^DD",9002313.02,9002313.022044,2050,21,3,0) patient". "^DD",9002313.02,9002313.022044,2050,"DT") 3141231 "^DD",9002313.02,9002313.022044,2055,0) INTERMEDIARY ID COUNTRY CODE^F^^0;7^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.022044,2055,3) Answer must be 1-4 characters in length. "^DD",9002313.02,9002313.022044,2055,21,0) ^^3^3^3141231^ "^DD",9002313.02,9002313.022044,2055,21,1,0) This is used to store NCPDP field B55-8U (Intermediary ID Country Code), "^DD",9002313.02,9002313.022044,2055,21,2,0) which is defined as "The associated Postal country code of the "^DD",9002313.02,9002313.022044,2055,21,3,0) associated Intermediary ID". "^DD",9002313.02,9002313.022044,2055,"DT") 3141231 "^DD",9002313.02,9002313.02354,0) SUBMISSION CLARIFICATION MLTPL SUB-FIELD^^420^2 "^DD",9002313.02,9002313.02354,0,"DT") 3100924 "^DD",9002313.02,9002313.02354,0,"IX","B",9002313.02354,.01) "^DD",9002313.02,9002313.02354,0,"NM","SUBMISSION CLARIFICATION MLTPL") "^DD",9002313.02,9002313.02354,0,"UP") 9002313.0201 "^DD",9002313.02,9002313.02354,.01,0) SUBMISSION CLRFCTN CODE CNTR^NJ2,0^^0;1^K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X "^DD",9002313.02,9002313.02354,.01,.1) SUBMISSION CLARIFICATION CODE COUNTER "^DD",9002313.02,9002313.02354,.01,1,0) ^.1 "^DD",9002313.02,9002313.02354,.01,1,1,0) 9002313.02354^B "^DD",9002313.02,9002313.02354,.01,1,1,1) S ^BPSC(DA(2),400,DA(1),354.01,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.02354,.01,1,1,2) K ^BPSC(DA(2),400,DA(1),354.01,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.02354,.01,3) Type a Number between 1 and 99, 0 Decimal Digits. "^DD",9002313.02,9002313.02354,.01,21,0) ^.001^1^1^3101020^^^ "^DD",9002313.02,9002313.02354,.01,21,1,0) This is a sequential counter of the Submission Clarification occurrences. "^DD",9002313.02,9002313.02354,.01,"DT") 3100819 "^DD",9002313.02,9002313.02354,420,0) SUBMISSION CLARIFICATION CODE^F^^1;1^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.02354,420,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.02354,420,21,0) ^.001^2^2^3101004^^^^ "^DD",9002313.02,9002313.02354,420,21,1,0) This is used to store NCPDP field 420-DK (Submission Clarification Code), "^DD",9002313.02,9002313.02354,420,21,2,0) which is defined as "Code indicating that the pharmacist is clarifying the submission." "^DD",9002313.02,9002313.02354,420,23,0) ^.001^10^10^3101004^^^ "^DD",9002313.02,9002313.02354,420,23,1,0) Examples: Since the patient will be out of "^DD",9002313.02,9002313.02354,420,23,2,0) state for the next three months, they have "^DD",9002313.02,9002313.02354,420,23,3,0) requested a three month supply of their "^DD",9002313.02,9002313.02354,420,23,4,0) medication. This situation can cause the "^DD",9002313.02,9002313.02354,420,23,5,0) claim to reject, because it was refilled too "^DD",9002313.02,9002313.02354,420,23,6,0) soon. By indicating an 03, the processor is "^DD",9002313.02,9002313.02354,420,23,7,0) made aware of the situation, and can properly "^DD",9002313.02,9002313.02354,420,23,8,0) adjudicate the claim. "^DD",9002313.02,9002313.02354,420,23,9,0) "^DD",9002313.02,9002313.02354,420,23,10,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.02354,420,"DT") 3100924 "^DD",9002313.02,9002313.023771,0) QUESTION NUMBER/LETTER MLTPL SUB-FIELD^^383^7 "^DD",9002313.02,9002313.023771,0,"DT") 3100902 "^DD",9002313.02,9002313.023771,0,"IX","B",9002313.023771,.01) "^DD",9002313.02,9002313.023771,0,"NM","QUESTION NUMBER/LETTER MLTPL") "^DD",9002313.02,9002313.023771,0,"UP") 9002313.0201 "^DD",9002313.02,9002313.023771,.01,0) QUESTION NUMBER/LETTER COUNTER^NJ2,0^^0;1^K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X "^DD",9002313.02,9002313.023771,.01,1,0) ^.1 "^DD",9002313.02,9002313.023771,.01,1,1,0) 9002313.023771^B "^DD",9002313.02,9002313.023771,.01,1,1,1) S ^BPSC(DA(2),400,DA(1),377.01,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.023771,.01,1,1,2) K ^BPSC(DA(2),400,DA(1),377.01,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.023771,.01,3) Type a number between 1 and 99, 0 decimal digits. "^DD",9002313.02,9002313.023771,.01,21,0) ^.001^1^1^3101020^^^^ "^DD",9002313.02,9002313.023771,.01,21,1,0) This is a sequential counter of Question Number/Letter occurrences. "^DD",9002313.02,9002313.023771,.01,23,0) ^.001^9^9^3101020^^^^ "^DD",9002313.02,9002313.023771,.01,23,1,0) Integer counter incremented as needed by BPS* software. "^DD",9002313.02,9002313.023771,.01,23,2,0) "^DD",9002313.02,9002313.023771,.01,23,3,0) Fields included in the set/logical grouping are: "^DD",9002313.02,9002313.023771,.01,23,4,0) Question Number/Letter (378-4B), "^DD",9002313.02,9002313.023771,.01,23,5,0) Question Percent Response (379-4D), "^DD",9002313.02,9002313.023771,.01,23,6,0) Question Date Response (380-4G), "^DD",9002313.02,9002313.023771,.01,23,7,0) Question Dollar Amount Response (381-4H), "^DD",9002313.02,9002313.023771,.01,23,8,0) Question Numeric Response (382-4J), "^DD",9002313.02,9002313.023771,.01,23,9,0) Question Alphanumeric Response (383-4K). "^DD",9002313.02,9002313.023771,.01,"DT") 3100902 "^DD",9002313.02,9002313.023771,378,0) QUESTION NUMBER/LETTER^F^^0;2^K:$L(X)>5!($L(X)<1) X "^DD",9002313.02,9002313.023771,378,3) Answer must be 1-5 characters. "^DD",9002313.02,9002313.023771,378,21,0) ^.001^3^3^3101004^^ "^DD",9002313.02,9002313.023771,378,21,1,0) This is used to store NCPDP field 378-4B (Question Number/Letter), "^DD",9002313.02,9002313.023771,378,21,2,0) which is defined as "Identifies the question number/letter that the question response "^DD",9002313.02,9002313.023771,378,21,3,0) applies to (part of the question information)." "^DD",9002313.02,9002313.023771,378,23,0) ^.001^2^2^3101004^^ "^DD",9002313.02,9002313.023771,378,23,1,0) Values to be determined by Trading Partner Agreement. "^DD",9002313.02,9002313.023771,378,23,2,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.023771,378,"DT") 3100902 "^DD",9002313.02,9002313.023771,379,0) QUESTION PERCENT RESPONSE^F^^0;3^K:$L(X)>7!($L(X)<1) X "^DD",9002313.02,9002313.023771,379,3) Answer must be 1-7 characters. "^DD",9002313.02,9002313.023771,379,21,0) ^.001^2^2^3101004^^ "^DD",9002313.02,9002313.023771,379,21,1,0) This is used to store NCPDP field 379-4D (Question Percent Response), "^DD",9002313.02,9002313.023771,379,21,2,0) which is defined as "Percent response to a question (part of the question information)." "^DD",9002313.02,9002313.023771,379,23,0) ^.001^2^2^3101004^^ "^DD",9002313.02,9002313.023771,379,23,1,0) Examples: 25.75% = 02575 or 0.5% = 0005 "^DD",9002313.02,9002313.023771,379,23,2,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.023771,379,"DT") 3100902 "^DD",9002313.02,9002313.023771,380,0) QUESTION DATE RESPONSE^F^^0;4^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.023771,380,3) Answer must be 1-10 characters. "^DD",9002313.02,9002313.023771,380,21,0) ^.001^2^2^3101004^^ "^DD",9002313.02,9002313.023771,380,21,1,0) This is used to store NCPDP field 380-4G (Question Date Response), "^DD",9002313.02,9002313.023771,380,21,2,0) which is defined as "Date response to a question (part of the question information)." "^DD",9002313.02,9002313.023771,380,23,0) ^.001^3^3^3101004^^ "^DD",9002313.02,9002313.023771,380,23,1,0) Format=CCYYMMDD "^DD",9002313.02,9002313.023771,380,23,2,0) "^DD",9002313.02,9002313.023771,380,23,3,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.023771,380,"DT") 3100902 "^DD",9002313.02,9002313.023771,381,0) QUESTION DOLLAR AMT RESPONSE^F^^0;5^K:$L(X)>13!($L(X)<1) X "^DD",9002313.02,9002313.023771,381,.1) QUESTION DOLLAR AMOUNT RESPONSE "^DD",9002313.02,9002313.023771,381,3) Answer must be 1-13 characters. "^DD",9002313.02,9002313.023771,381,21,0) ^.001^2^2^3101004^^^ "^DD",9002313.02,9002313.023771,381,21,1,0) This is used to store NCPDP field 381-4H (Question Dollar Amount Response), "^DD",9002313.02,9002313.023771,381,21,2,0) which is defined as "Dollar Amount response to a question (part of the question information)." "^DD",9002313.02,9002313.023771,381,23,0) ^.001^2^2^3101004^^^ "^DD",9002313.02,9002313.023771,381,23,1,0) Format=s$$$$$$$$$cc "^DD",9002313.02,9002313.023771,381,23,2,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.023771,381,"DT") 3100902 "^DD",9002313.02,9002313.023771,382,0) QUESTION NUMERIC RESPONSE^F^^0;6^K:$L(X)>13!($L(X)<1) X "^DD",9002313.02,9002313.023771,382,3) Answer must be 1-13 characters. "^DD",9002313.02,9002313.023771,382,21,0) ^.001^2^2^3101004^^^ "^DD",9002313.02,9002313.023771,382,21,1,0) This is used to store NCPDP field 382-4J (Question Numeric Response), "^DD",9002313.02,9002313.023771,382,21,2,0) which is defined as "Numeric response to a question (part of the question information)." "^DD",9002313.02,9002313.023771,382,23,0) ^.001^1^1^3101004^^^ "^DD",9002313.02,9002313.023771,382,23,1,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.023771,382,"DT") 3100902 "^DD",9002313.02,9002313.023771,383,0) QUESTION ALPHANUMERIC RESPONSE^F^^0;7^K:$L(X)>32!($L(X)<1) X "^DD",9002313.02,9002313.023771,383,3) Answer must be 1-32 characters. "^DD",9002313.02,9002313.023771,383,21,0) ^.001^2^2^3101004^^^ "^DD",9002313.02,9002313.023771,383,21,1,0) This is used to store NCPDP field 383-4K (Question Alphanumeric Response), "^DD",9002313.02,9002313.023771,383,21,2,0) which is defined as "Alphanumeric response to a question (part of the question information)." "^DD",9002313.02,9002313.023771,383,23,0) ^.001^1^1^3101004^^^ "^DD",9002313.02,9002313.023771,383,23,1,0) REQUEST ADDITIONAL DOCUMENTATION SEGMENT. "^DD",9002313.02,9002313.023771,383,"DT") 3100902 "^DD",9002313.02,9002313.0401,0) COB OTHER PAYMENTS SUB-FIELD^NL^2149^15 "^DD",9002313.02,9002313.0401,0,"DT") 3210330 "^DD",9002313.02,9002313.0401,0,"IX","B",9002313.0401,.01) "^DD",9002313.02,9002313.0401,0,"NM","COB OTHER PAYMENTS") "^DD",9002313.02,9002313.0401,0,"UP") 9002313.0201 "^DD",9002313.02,9002313.0401,.01,0) COB OTHER PAYMENT COUNTER^F^^0;1^K:$L(X)>1!($L(X)<1) X "^DD",9002313.02,9002313.0401,.01,1,0) ^.1 "^DD",9002313.02,9002313.0401,.01,1,1,0) 9002313.0401^B "^DD",9002313.02,9002313.0401,.01,1,1,1) S ^BPSC(DA(2),400,DA(1),337,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.0401,.01,1,1,2) K ^BPSC(DA(2),400,DA(1),337,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.0401,.01,3) Answer must be 1 character in length. "^DD",9002313.02,9002313.0401,.01,21,0) ^^2^2^3080604^ "^DD",9002313.02,9002313.0401,.01,21,1,0) This is a multiple counter field to store multiple COB payments received "^DD",9002313.02,9002313.0401,.01,21,2,0) from other payers. "^DD",9002313.02,9002313.0401,.01,"DT") 3080604 "^DD",9002313.02,9002313.0401,338,0) OTHER PAYER COVERAGE TYPE^F^^0;2^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0401,338,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0401,338,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0401,338,21,1,0) Code identifying the type of Other Payer ID (340-7C). NCPDP standard "^DD",9002313.02,9002313.0401,338,21,2,0) field 338-5C. "^DD",9002313.02,9002313.0401,338,23,0) ^.001^2^2^3101020^^^^ "^DD",9002313.02,9002313.0401,338,23,1,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.0401,338,23,2,0) RESPONSE COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.0401,338,"DT") 3080103 "^DD",9002313.02,9002313.0401,339,0) OTHER PAYER ID QUALIFIER^F^^0;3^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0401,339,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0401,339,21,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0401,339,21,1,0) Code qualifying the Other Payer ID (340-7C). NCPDP standard field 339-6C. "^DD",9002313.02,9002313.0401,339,23,0) ^.001^2^2^3101020^^^^ "^DD",9002313.02,9002313.0401,339,23,1,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.0401,339,23,2,0) RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT. "^DD",9002313.02,9002313.0401,339,"DT") 3080103 "^DD",9002313.02,9002313.0401,340,0) OTHER PAYER ID^F^^0;4^K:$L(X)>12!($L(X)<12) X "^DD",9002313.02,9002313.0401,340,3) Answer must be 12 characters in length "^DD",9002313.02,9002313.0401,340,21,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0401,340,21,1,0) ID assigned to the payer. NCPDP standard field 340-7C. "^DD",9002313.02,9002313.0401,340,23,0) ^.001^3^3^3101020^^^^ "^DD",9002313.02,9002313.0401,340,23,1,0) Qualified by Other Payer ID Qualifier (339-6C). "^DD",9002313.02,9002313.0401,340,23,2,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.0401,340,23,3,0) RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT. "^DD",9002313.02,9002313.0401,340,"DT") 3080103 "^DD",9002313.02,9002313.0401,341,0) OTHER PAYER AMOUNT PAID COUNT^F^^0;6^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.0401,341,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.0401,341,21,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0401,341,21,1,0) Count of the payer amount paid occurrences. NCPDP standard field 341-HB. "^DD",9002313.02,9002313.0401,341,23,0) ^.001^1^1^3101021^^^^ "^DD",9002313.02,9002313.0401,341,23,1,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.0401,341,"DT") 3080103 "^DD",9002313.02,9002313.0401,342,0) OTHER PAYER AMT PAID QUALIFIER^9002313.401342A^^1;0 "^DD",9002313.02,9002313.0401,342,21,0) ^.001^1^1^3101021^^^^ "^DD",9002313.02,9002313.0401,342,21,1,0) This sub-file stores Other Paid Amount Qualifier values. "^DD",9002313.02,9002313.0401,342,23,0) ^.001^1^1^3101021^^^^ "^DD",9002313.02,9002313.0401,342,23,1,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.0401,342,"DT") 3210330 "^DD",9002313.02,9002313.0401,353,0) OTHER PAYER-PAT RESP AMT CNT^F^^0;8^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0401,353,.1) OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT COUNT "^DD",9002313.02,9002313.0401,353,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.0401,353,21,0) ^.001^3^3^3101014^^^^ "^DD",9002313.02,9002313.0401,353,21,1,0) This is used to store NCPDP field 353-NR (Other Payer-Patient Responsibility Amount Count), "^DD",9002313.02,9002313.0401,353,21,2,0) which is defined as "Count of Other Payer-Patient Responsibility Amount (352-NQ) and "^DD",9002313.02,9002313.0401,353,21,3,0) Other Payer-Patient Responsibility Amount Qualifier (351-NP) occurrences." "^DD",9002313.02,9002313.0401,353,23,0) ^.001^1^1^3101014^^^ "^DD",9002313.02,9002313.0401,353,23,1,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.0401,353,"DT") 3210330 "^DD",9002313.02,9002313.0401,353.01,0) OTHER PAYER-PATIENT RESP MLTPL^9002313.401353^^3;0 "^DD",9002313.02,9002313.0401,353.01,21,0) ^.001^1^1^3101021^^^^ "^DD",9002313.02,9002313.0401,353.01,21,1,0) This sub-file stores OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT values. "^DD",9002313.02,9002313.0401,392,0) BENEFIT STAGE COUNT^F^^0;9^K:$L(X)>3!($L(X)<1) X "^DD",9002313.02,9002313.0401,392,3) Answer must be 1-3 characters. "^DD",9002313.02,9002313.0401,392,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.0401,392,21,1,0) This is used to store NCPDP field 392-MU (Benefit Stage Count), "^DD",9002313.02,9002313.0401,392,21,2,0) which is defined as "Count of Benefit Stage Amount (394-MW) occurrences." "^DD",9002313.02,9002313.0401,392,23,0) ^^2^2^3100901^ "^DD",9002313.02,9002313.0401,392,23,1,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT "^DD",9002313.02,9002313.0401,392,23,2,0) RESPONSE PRICING SEGMENT. "^DD",9002313.02,9002313.0401,392,"DT") 3100901 "^DD",9002313.02,9002313.0401,392.01,0) BENEFIT STAGE MLTPL^9002313.401392^^4;0 "^DD",9002313.02,9002313.0401,392.01,21,0) ^.001^1^1^3101021^^^ "^DD",9002313.02,9002313.0401,392.01,21,1,0) This sub-file stores BENEFIT STAGE values. "^DD",9002313.02,9002313.0401,443,0) OTHER PAYER DATE^FO^^0;5^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0401,443,2) S Y(0)=Y S Y=$$FM3EXT^BPSOSU1($E(Y,3,10)) "^DD",9002313.02,9002313.0401,443,2.1) S Y=$$FM3EXT^BPSOSU1($E(Y,3,10)) "^DD",9002313.02,9002313.0401,443,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0401,443,21,0) ^^2^2^3080613^^ "^DD",9002313.02,9002313.0401,443,21,1,0) Payment or denial date of the claim submitted to the other payer. Used "^DD",9002313.02,9002313.0401,443,21,2,0) for coordination of benefits. "^DD",9002313.02,9002313.0401,443,23,0) ^.001^10^10^3101014^^ "^DD",9002313.02,9002313.0401,443,23,1,0) Format=CCYYMMDD "^DD",9002313.02,9002313.0401,443,23,2,0) CC=Century "^DD",9002313.02,9002313.0401,443,23,3,0) YY=Year "^DD",9002313.02,9002313.0401,443,23,4,0) MM=Month "^DD",9002313.02,9002313.0401,443,23,5,0) DD=Day "^DD",9002313.02,9002313.0401,443,23,6,0) "^DD",9002313.02,9002313.0401,443,23,7,0) Examples: If the other payer denial date was August 1,1999, this field "^DD",9002313.02,9002313.0401,443,23,8,0) would reflect: 19990801. "^DD",9002313.02,9002313.0401,443,23,9,0) "^DD",9002313.02,9002313.0401,443,23,10,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.0401,443,"DT") 3090309 "^DD",9002313.02,9002313.0401,471,0) OTHER PAYER REJECT COUNT^F^^0;7^K:$L(X)>2!($L(X)<2) X "^DD",9002313.02,9002313.0401,471,3) Answer must be 2 characters in length. "^DD",9002313.02,9002313.0401,471,21,0) ^^1^1^3031125^ "^DD",9002313.02,9002313.0401,471,21,1,0) Count of 'Other Payer Reject Code' (472) occurrences. "^DD",9002313.02,9002313.0401,471,"DT") 3080102 "^DD",9002313.02,9002313.0401,472,0) OTHER PAYER REJECT CODE^9002313.401472A^^2;0 "^DD",9002313.02,9002313.0401,472,21,0) ^.001^1^1^3101020^^^ "^DD",9002313.02,9002313.0401,472,21,1,0) This sub-file is to store reject values received from other payers. "^DD",9002313.02,9002313.0401,472,"DT") 3210330 "^DD",9002313.02,9002313.0401,993,0) INTERNAL CONTROL NUMBER^F^^0;10^K:$L(X)>32!($L(X)<1) X "^DD",9002313.02,9002313.0401,993,3) Answer must be 1-32 characters. "^DD",9002313.02,9002313.0401,993,21,0) ^.001^3^3^3101014^^^ "^DD",9002313.02,9002313.0401,993,21,1,0) This is used to store NCPDP field 993-A7 (Internal Control Number), "^DD",9002313.02,9002313.0401,993,21,2,0) which is defined as "Number assigned by the processor to identify an adjudicated claim when "^DD",9002313.02,9002313.0401,993,21,3,0) supplied in payer-to-payer coordination of benefits only." "^DD",9002313.02,9002313.0401,993,23,0) ^.001^2^2^3101014^^ "^DD",9002313.02,9002313.0401,993,23,1,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.0401,993,23,2,0) RESPONSE STATUS SEGMENT. "^DD",9002313.02,9002313.0401,993,"DT") 3100901 "^DD",9002313.02,9002313.0401,2149,0) OTHER PAYER RECONCILIATION ID^FJ30^^0;11^K:$L(X)>30!($L(X)<1) X "^DD",9002313.02,9002313.0401,2149,3) Enter an ID between 1 and 30 characters. "^DD",9002313.02,9002313.0401,2149,21,0) ^^5^5^3180516^ "^DD",9002313.02,9002313.0401,2149,21,1,0) NCPDP field C49-9V - Other Payer Reconciliation ID. Reconciliation ID "^DD",9002313.02,9002313.0401,2149,21,2,0) (B98-34) as reported by the Other Payer for Paid/Accepted transactions OR "^DD",9002313.02,9002313.0401,2149,21,3,0) for Information Reporting transactions, the designated default value for "^DD",9002313.02,9002313.0401,2149,21,4,0) reporting a previous payer's rejected response as designated in the Other "^DD",9002313.02,9002313.0401,2149,21,5,0) Payer Reject Code value(s) reported in the COB claim. "^DD",9002313.02,9002313.0401,2149,"DT") 3180516 "^DD",9002313.02,9002313.0501,0) COMPOUND REPEATING FIELDS SUB-FIELD^^362.01^8 "^DD",9002313.02,9002313.0501,0,"DT") 3210330 "^DD",9002313.02,9002313.0501,0,"IX","B",9002313.0501,.01) "^DD",9002313.02,9002313.0501,0,"NM","COMPOUND REPEATING FIELDS") "^DD",9002313.02,9002313.0501,0,"UP") 9002313.0201 "^DD",9002313.02,9002313.0501,.01,0) COMPOUND REPEATING COUNT^F^^0;1^K:$L(X)>1!($L(X)<1) X "^DD",9002313.02,9002313.0501,.01,1,0) ^.1 "^DD",9002313.02,9002313.0501,.01,1,1,0) 9002313.0501^B "^DD",9002313.02,9002313.0501,.01,1,1,1) S ^BPSC(DA(2),400,DA(1),447,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.0501,.01,1,1,2) K ^BPSC(DA(2),400,DA(1),447,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.0501,.01,3) Answer must be 1 character in length. "^DD",9002313.02,9002313.0501,.01,21,0) ^^1^1^3031216^ "^DD",9002313.02,9002313.0501,.01,21,1,0) Count of Compounds for this medication. "^DD",9002313.02,9002313.0501,.01,"DT") 3080102 "^DD",9002313.02,9002313.0501,362,0) COMPOUND INGRED MOD CODE CNT^F^^0;7^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.0501,362,.1) COMPOUND INGREDIENT MODIFIER CODE COUNT "^DD",9002313.02,9002313.0501,362,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.0501,362,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.0501,362,21,1,0) This is used to store NCPDP field 362-2G (Compound Ingredient Modifier Code Count), "^DD",9002313.02,9002313.0501,362,21,2,0) which is defined as "Code indicating the number of Compound Ingredient Modifier Code (363-2H)" "^DD",9002313.02,9002313.0501,362,23,0) ^^1^1^3100901^ "^DD",9002313.02,9002313.0501,362,23,1,0) REQUEST COMPOUND SEGMENT. "^DD",9002313.02,9002313.0501,362,"DT") 3210330 "^DD",9002313.02,9002313.0501,362.01,0) COMPND INGRED MDFR MLTPL^9002313.05011^^1;0 "^DD",9002313.02,9002313.0501,362.01,21,0) ^^1^1^3101021^ "^DD",9002313.02,9002313.0501,362.01,21,1,0) This sub-file stores Compound Ingredient Modifier values. "^DD",9002313.02,9002313.0501,448,0) COMPOUND INGREDIENT QUANTITY^F^^0;4^K:$L(X)>12!($L(X)<12) X "^DD",9002313.02,9002313.0501,448,3) Answer must be 12 characters in length "^DD",9002313.02,9002313.0501,448,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0501,448,21,1,0) Amount expressed in metric decimal units of the product included in the "^DD",9002313.02,9002313.0501,448,21,2,0) compound mixture. NCPDP standard field 448-ED. "^DD",9002313.02,9002313.0501,448,23,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0501,448,23,1,0) Format=9999999.999 "^DD",9002313.02,9002313.0501,448,23,2,0) REQUEST COMPOUND SEGMENT. "^DD",9002313.02,9002313.0501,448,"DT") 3080103 "^DD",9002313.02,9002313.0501,449,0) COMPOUND INGREDIENT DRUG COST^F^^0;5^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0501,449,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0501,449,21,0) ^^3^3^3080103^ "^DD",9002313.02,9002313.0501,449,21,1,0) Ingredient cost for the metric decimal quantity of the product included "^DD",9002313.02,9002313.0501,449,21,2,0) in the compound mixture indicated in Compound Ingredient Quantity "^DD",9002313.02,9002313.0501,449,21,3,0) (Field 448-ED). NCPDP standard field 449-EE. "^DD",9002313.02,9002313.0501,449,23,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0501,449,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.0501,449,23,2,0) REQUEST COMPOUND SEGMENT. "^DD",9002313.02,9002313.0501,449,"DT") 3080103 "^DD",9002313.02,9002313.0501,488,0) COMPOUND PRODUCT ID QUALIFIER^F^^0;2^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0501,488,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0501,488,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0501,488,21,1,0) Code qualifying the type of product dispensed. NCPDP standard field "^DD",9002313.02,9002313.0501,488,21,2,0) 488-RE. "^DD",9002313.02,9002313.0501,488,23,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0501,488,23,1,0) Qualifies Compound Product ID (489-TE). "^DD",9002313.02,9002313.0501,488,23,2,0) REQUEST COMPOUND SEGMENT. "^DD",9002313.02,9002313.0501,488,"DT") 3210330 "^DD",9002313.02,9002313.0501,489,0) COMPOUND PRODUCT ID^F^^0;3^K:$L(X)>21!($L(X)<21) X "^DD",9002313.02,9002313.0501,489,3) Answer must be 21 characters in length "^DD",9002313.02,9002313.0501,489,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0501,489,21,1,0) Product identification of an ingredient used in a compound. NCPDP "^DD",9002313.02,9002313.0501,489,21,2,0) standard field 489-TE. "^DD",9002313.02,9002313.0501,489,23,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0501,489,23,1,0) Qualified by Compound Product ID Qualifier (488-RE). "^DD",9002313.02,9002313.0501,489,23,2,0) REQUEST COMPOUND SEGMENT. "^DD",9002313.02,9002313.0501,489,"DT") 3080103 "^DD",9002313.02,9002313.0501,490,0) COMP INGRED BASIS COST DETERM^F^^0;6^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0501,490,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0501,490,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.0501,490,21,1,0) Code indicating the method by which the drug cost of an ingredient used "^DD",9002313.02,9002313.0501,490,21,2,0) in a compound was calculated. NCPDP standard field 490-UE. "^DD",9002313.02,9002313.0501,490,23,0) ^^1^1^3080103^ "^DD",9002313.02,9002313.0501,490,23,1,0) REQUEST COMPOUND SEGMENT. "^DD",9002313.02,9002313.0501,490,"DT") 3210330 "^DD",9002313.02,9002313.05011,0) COMPND INGRED MDFR MLTPL SUB-FIELD^^363^2 "^DD",9002313.02,9002313.05011,0,"DT") 3100901 "^DD",9002313.02,9002313.05011,0,"IX","B",9002313.05011,.01) "^DD",9002313.02,9002313.05011,0,"NM","COMPND INGRED MDFR MLTPL") "^DD",9002313.02,9002313.05011,0,"UP") 9002313.0501 "^DD",9002313.02,9002313.05011,.01,0) COMPND INGRED MDFR COUNTER^NJ2,0^^0;1^K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X "^DD",9002313.02,9002313.05011,.01,1,0) ^.1 "^DD",9002313.02,9002313.05011,.01,1,1,0) 9002313.05011^B "^DD",9002313.02,9002313.05011,.01,1,1,1) S ^BPSC(DA(3),400,DA(2),447,DA(1),1,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.05011,.01,1,1,2) K ^BPSC(DA(3),400,DA(2),447,DA(1),1,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.05011,.01,3) Type a number between 1 and 99, 0 decimal digits. "^DD",9002313.02,9002313.05011,.01,21,0) ^^1^1^3101021^ "^DD",9002313.02,9002313.05011,.01,21,1,0) This is a sequential counter of Compound Ingredient Modifier entries. "^DD",9002313.02,9002313.05011,.01,"DT") 3100901 "^DD",9002313.02,9002313.05011,363,0) COMPOUND INGRED MODIFIER CODE^F^^0;2^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.05011,363,.1) COMPOUND INGREDIENT MODIFIER CODE "^DD",9002313.02,9002313.05011,363,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.05011,363,21,0) ^.001^3^3^3100901^^ "^DD",9002313.02,9002313.05011,363,21,1,0) This is used to store NCPDP field 363-2H (Compound Ingredient Modifier Code), "^DD",9002313.02,9002313.05011,363,21,2,0) which is defined as "Identifies special circumstances related to the dispensing/payment "^DD",9002313.02,9002313.05011,363,21,3,0) of the product as identified in the Compound Product ID (498-TE)." "^DD",9002313.02,9002313.05011,363,23,0) ^^1^1^3100901^ "^DD",9002313.02,9002313.05011,363,23,1,0) REQUEST COMPOUND SEGMENT. "^DD",9002313.02,9002313.05011,363,"DT") 3100901 "^DD",9002313.02,9002313.0601,0) OTHER AMT CLAIMED MULTIPLE SUB-FIELD^^480^3 "^DD",9002313.02,9002313.0601,0,"DT") 3210330 "^DD",9002313.02,9002313.0601,0,"IX","B",9002313.0601,.01) "^DD",9002313.02,9002313.0601,0,"NM","OTHER AMT CLAIMED MULTIPLE") "^DD",9002313.02,9002313.0601,0,"UP") 9002313.0201 "^DD",9002313.02,9002313.0601,.01,0) OTHER AMT CLAIMED COUNTER^F^^0;1^K:$L(X)>2!($L(X)<1) X "^DD",9002313.02,9002313.0601,.01,1,0) ^.1 "^DD",9002313.02,9002313.0601,.01,1,1,0) 9002313.0601^B "^DD",9002313.02,9002313.0601,.01,1,1,1) S ^BPSC(DA(2),400,DA(1),478.01,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.0601,.01,1,1,2) K ^BPSC(DA(2),400,DA(1),478.01,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.0601,.01,3) Answer must be 1-2 characters. "^DD",9002313.02,9002313.0601,.01,21,0) ^.001^2^2^3101020^^^^ "^DD",9002313.02,9002313.0601,.01,21,1,0) This is the number of other claimed amount entries in the sub-file. "^DD",9002313.02,9002313.0601,.01,21,2,0) It is used for coordination of benefits. "^DD",9002313.02,9002313.0601,.01,23,0) ^.001^1^1^3101020^^^^ "^DD",9002313.02,9002313.0601,.01,23,1,0) Sequential counter of Other Amount Claimed occurrences. "^DD",9002313.02,9002313.0601,.01,"DT") 3101013 "^DD",9002313.02,9002313.0601,479,0) OTHER AMT CLAIMED SUBM QLFR^F^^0;2^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0601,479,.1) OTHER AMOUNT CLAIMED SUBMITTED QUALIFIER "^DD",9002313.02,9002313.0601,479,3) Answer must be 4 characters in length. "^DD",9002313.02,9002313.0601,479,21,0) ^.001^2^2^3101020^^^^ "^DD",9002313.02,9002313.0601,479,21,1,0) This is the code identifying the additional incurred cost claimed in Other Amount Claimed Submitted (480-H9). "^DD",9002313.02,9002313.0601,479,21,2,0) It is NCPDP field 479-H8. "^DD",9002313.02,9002313.0601,479,23,0) ^.001^1^1^3101020^^^^ "^DD",9002313.02,9002313.0601,479,23,1,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0601,479,"DT") 3210330 "^DD",9002313.02,9002313.0601,480,0) OTHER AMT CLAIMED SUBMITTED^F^^0;3^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0601,480,3) Answer must be 10 characters in length. "^DD",9002313.02,9002313.0601,480,21,0) ^.001^2^2^3101020^^^^ "^DD",9002313.02,9002313.0601,480,21,1,0) This is the amount representing the additional incurred costs for a dispensed prescription or service. "^DD",9002313.02,9002313.0601,480,21,2,0) It is NCPDP field 480-H9. "^DD",9002313.02,9002313.0601,480,23,0) ^.001^8^8^3101020^^^^ "^DD",9002313.02,9002313.0601,480,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.0601,480,23,2,0) "^DD",9002313.02,9002313.0601,480,23,3,0) Qualified by Other Amount Claimed Submitted Qualifier (479-H8). "^DD",9002313.02,9002313.0601,480,23,4,0) "^DD",9002313.02,9002313.0601,480,23,5,0) Examples: If the other amount claimed submitted is $12.55, this field "^DD",9002313.02,9002313.0601,480,23,6,0) would reflect: 125E. "^DD",9002313.02,9002313.0601,480,23,7,0) "^DD",9002313.02,9002313.0601,480,23,8,0) REQUEST PRICING SEGMENT. "^DD",9002313.02,9002313.0601,480,"DT") 3210330 "^DD",9002313.02,9002313.0701,0) CLINICAL DIAGNOSIS SUB-FIELD^^492^3 "^DD",9002313.02,9002313.0701,0,"DT") 3080104 "^DD",9002313.02,9002313.0701,0,"IX","B",9002313.0701,.01) "^DD",9002313.02,9002313.0701,0,"NM","CLINICAL DIAGNOSIS") "^DD",9002313.02,9002313.0701,0,"UP") 9002313.0201 "^DD",9002313.02,9002313.0701,.01,0) DIAGNOSIS COUNTER^F^^0;1^K:$L(X)>1!($L(X)<1) X "^DD",9002313.02,9002313.0701,.01,1,0) ^.1 "^DD",9002313.02,9002313.0701,.01,1,1,0) 9002313.0701^B "^DD",9002313.02,9002313.0701,.01,1,1,1) S ^BPSC(DA(2),400,DA(1),491.01,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.0701,.01,1,1,2) K ^BPSC(DA(2),400,DA(1),491.01,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.0701,.01,3) Answer must be 1 character in length. "^DD",9002313.02,9002313.0701,.01,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0701,.01,21,1,0) The number of diagnosis codes defined for this medication order. "^DD",9002313.02,9002313.0701,.01,"DT") 3080104 "^DD",9002313.02,9002313.0701,424,0) DIAGNOSIS CODE^F^^0;3^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0701,424,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.0701,424,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0701,424,21,1,0) Code identifying the diagnosis of the patient. NCPDP standard field "^DD",9002313.02,9002313.0701,424,21,2,0) 424-DO. "^DD",9002313.02,9002313.0701,424,23,0) ^^3^3^3080104^ "^DD",9002313.02,9002313.0701,424,23,1,0) Qualified by a Diagnosis Code Qualifier (492-WE). The format must "^DD",9002313.02,9002313.0701,424,23,2,0) adhere to the owner's code set rules and formats. "^DD",9002313.02,9002313.0701,424,23,3,0) REQUEST CLINICAL SEGMENT. "^DD",9002313.02,9002313.0701,424,"DT") 3080104 "^DD",9002313.02,9002313.0701,492,0) DIAGNOSIS CODE QUALIFIER^F^^0;2^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0701,492,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0701,492,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0701,492,21,1,0) Code qualifying the Diagnosis Code (424-DO). NCPDP standard field 492-WE. "^DD",9002313.02,9002313.0701,492,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0701,492,23,1,0) REQUEST CLINICAL SEGMENT. "^DD",9002313.02,9002313.0701,492,"DT") 3080104 "^DD",9002313.02,9002313.0801,0) CLINICAL INFORMATION SUB-FIELD^^499^6 "^DD",9002313.02,9002313.0801,0,"DT") 3080104 "^DD",9002313.02,9002313.0801,0,"IX","B",9002313.0801,.01) "^DD",9002313.02,9002313.0801,0,"NM","CLINICAL INFORMATION") "^DD",9002313.02,9002313.0801,0,"UP") 9002313.0201 "^DD",9002313.02,9002313.0801,.01,0) CLINICAL INFORMATION COUNT^F^^0;1^K:$L(X)>1!($L(X)<1) X "^DD",9002313.02,9002313.0801,.01,1,0) ^.1 "^DD",9002313.02,9002313.0801,.01,1,1,0) 9002313.0801^B "^DD",9002313.02,9002313.0801,.01,1,1,1) S ^BPSC(DA(2),400,DA(1),493.01,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.0801,.01,1,1,2) K ^BPSC(DA(2),400,DA(1),493.01,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.0801,.01,3) Answer must be 1 character in length. "^DD",9002313.02,9002313.0801,.01,21,0) ^^1^1^3040126^ "^DD",9002313.02,9002313.0801,.01,21,1,0) The number of clinical indicator records for the medication order. "^DD",9002313.02,9002313.0801,.01,"DT") 3080104 "^DD",9002313.02,9002313.0801,494,0) MEASUREMENT DATE^F^^0;2^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.0801,494,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.0801,494,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0801,494,21,1,0) Date clinical information was collected or measured. NCPDP standard "^DD",9002313.02,9002313.0801,494,21,2,0) field 494-ZE. "^DD",9002313.02,9002313.0801,494,23,0) ^^8^8^3080104^ "^DD",9002313.02,9002313.0801,494,23,1,0) Format=CCYYMMDD "^DD",9002313.02,9002313.0801,494,23,2,0) "^DD",9002313.02,9002313.0801,494,23,3,0) CC=Century "^DD",9002313.02,9002313.0801,494,23,4,0) YY=Year "^DD",9002313.02,9002313.0801,494,23,5,0) MM=Month "^DD",9002313.02,9002313.0801,494,23,6,0) DD=Day "^DD",9002313.02,9002313.0801,494,23,7,0) "^DD",9002313.02,9002313.0801,494,23,8,0) REQUEST CLINICAL SEGMENT. "^DD",9002313.02,9002313.0801,494,"DT") 3080104 "^DD",9002313.02,9002313.0801,495,0) MEASUREMENT TIME^F^^0;3^K:$L(X)>6!($L(X)<6) X "^DD",9002313.02,9002313.0801,495,3) Answer must be 6 characters in length "^DD",9002313.02,9002313.0801,495,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0801,495,21,1,0) Time clinical information was collected or measured. NCPDP standard "^DD",9002313.02,9002313.0801,495,21,2,0) field 495-H1. "^DD",9002313.02,9002313.0801,495,23,0) ^^8^8^3080104^ "^DD",9002313.02,9002313.0801,495,23,1,0) Format: HHMM "^DD",9002313.02,9002313.0801,495,23,2,0) "^DD",9002313.02,9002313.0801,495,23,3,0) HH=Hour "^DD",9002313.02,9002313.0801,495,23,4,0) MM=Minute "^DD",9002313.02,9002313.0801,495,23,5,0) "^DD",9002313.02,9002313.0801,495,23,6,0) Examples: Reported in military time. Two o'clock P.M.=1400. "^DD",9002313.02,9002313.0801,495,23,7,0) "^DD",9002313.02,9002313.0801,495,23,8,0) REQUEST CLINICAL SEGMENT. "^DD",9002313.02,9002313.0801,495,"DT") 3080104 "^DD",9002313.02,9002313.0801,496,0) MEASUREMENT DIMENSION^F^^0;4^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0801,496,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0801,496,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0801,496,21,1,0) Code indicating the clinical domain of the observed value in Measurement "^DD",9002313.02,9002313.0801,496,21,2,0) Value (499-H4). NCPDP standard field 496-H2. "^DD",9002313.02,9002313.0801,496,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0801,496,23,1,0) REQUEST CLINICAL SEGMENT. "^DD",9002313.02,9002313.0801,496,"DT") 3080104 "^DD",9002313.02,9002313.0801,497,0) MEASUREMENT UNIT^F^^0;5^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.0801,497,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.0801,497,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.0801,497,21,1,0) Code indicating the metric or English units used with the clinical "^DD",9002313.02,9002313.0801,497,21,2,0) information. NCPDP standard field 497-H3. "^DD",9002313.02,9002313.0801,497,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0801,497,23,1,0) REQUEST CLINICAL SEGMENT. "^DD",9002313.02,9002313.0801,497,"DT") 3080104 "^DD",9002313.02,9002313.0801,499,0) MEASUREMENT VALUE^F^^0;6^K:$L(X)>17!($L(X)<17) X "^DD",9002313.02,9002313.0801,499,3) Answer must be 17 characters in length "^DD",9002313.02,9002313.0801,499,21,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.0801,499,21,1,0) Actual value of clinical information. NCPDP standard field 499-H4. "^DD",9002313.02,9002313.0801,499,23,0) ^^4^4^3080104^ "^DD",9002313.02,9002313.0801,499,23,1,0) Blood pressure entered in XXX/YYY format in which XXX=systolic, "^DD",9002313.02,9002313.0801,499,23,2,0) /=divider, and YYY is diastolic. Temperature entered in XXX.X format "^DD",9002313.02,9002313.0801,499,23,3,0) always including decimal point. "^DD",9002313.02,9002313.0801,499,23,4,0) REQUEST CLINICAL SEGMENT. "^DD",9002313.02,9002313.0801,499,"DT") 3080104 "^DD",9002313.02,9002313.0901,0) PRIOR AUTH SUPPORTING DOCUMENT SUB-FIELD^^.01^1 "^DD",9002313.02,9002313.0901,0,"DT") 3210330 "^DD",9002313.02,9002313.0901,0,"NM","PRIOR AUTH SUPPORTING DOCUMENT") "^DD",9002313.02,9002313.0901,0,"UP") 9002313.0201 "^DD",9002313.02,9002313.0901,.01,0) PRIOR AUTH SUPPORTING DOCUMENT^WL^^0;1^Q "^DD",9002313.02,9002313.0901,.01,.1) PRIOR AUTHORIZATION SUPPORTING DOCUMENTATION "^DD",9002313.02,9002313.0901,.01,3) Enter free text any prior authorization supporting information. "^DD",9002313.02,9002313.0901,.01,21,0) ^^1^1^3101004^ "^DD",9002313.02,9002313.0901,.01,21,1,0) This is used to store NCPDP field 498-PP (Prior Authorization Supporting Documentation). "^DD",9002313.02,9002313.0901,.01,23,0) ^.001^4^4^3101004^^ "^DD",9002313.02,9002313.0901,.01,23,1,0) Could be used, if applicable, to supply information not already included "^DD",9002313.02,9002313.0901,.01,23,2,0) in NCPDP data fields that may be required to process a prior "^DD",9002313.02,9002313.0901,.01,23,3,0) authorization transaction. "^DD",9002313.02,9002313.0901,.01,23,4,0) REQUEST PRIOR AUTHORIZATION SEGMENT. "^DD",9002313.02,9002313.0901,.01,"DT") 3210330 "^DD",9002313.02,9002313.1001,0) DUR PPS REPEATING FIELDS SUB-FIELD^^476^7 "^DD",9002313.02,9002313.1001,0,"DT") 3210331 "^DD",9002313.02,9002313.1001,0,"IX","B",9002313.1001,.01) "^DD",9002313.02,9002313.1001,0,"NM","DUR PPS REPEATING FIELDS") "^DD",9002313.02,9002313.1001,0,"UP") 9002313.0201 "^DD",9002313.02,9002313.1001,.01,0) DUR PPS CODE COUNT^F^^0;1^K:$L(X)>3!($L(X)<3) X "^DD",9002313.02,9002313.1001,.01,1,0) ^.1 "^DD",9002313.02,9002313.1001,.01,1,1,0) 9002313.1001^B "^DD",9002313.02,9002313.1001,.01,1,1,1) S ^BPSC(DA(2),400,DA(1),473.01,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.1001,.01,1,1,2) K ^BPSC(DA(2),400,DA(1),473.01,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.1001,.01,3) Answer must be 3 characters in length "^DD",9002313.02,9002313.1001,.01,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.1001,.01,21,1,0) The number of DUR messages that were returned in the response message. "^DD",9002313.02,9002313.1001,.01,21,2,0) NCPDP standard field 473-7E. "^DD",9002313.02,9002313.1001,.01,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.1001,.01,23,1,0) REQUEST DUR/PPS SEGMENT. "^DD",9002313.02,9002313.1001,.01,"DT") 3080104 "^DD",9002313.02,9002313.1001,439,0) REASON FOR SERVICE CODE^F^^0;2^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.1001,439,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.1001,439,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.1001,439,21,1,0) Code identifying the type of utilization conflict detected or the reason "^DD",9002313.02,9002313.1001,439,21,2,0) for the pharmacist's professional service. NCPDP standard field 439-E4. "^DD",9002313.02,9002313.1001,439,23,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.1001,439,23,1,0) REQUEST DUR/PPS SEGMENT. "^DD",9002313.02,9002313.1001,439,23,2,0) RESPONSE DUR/PPS SEGMENT. "^DD",9002313.02,9002313.1001,439,"DT") 3080104 "^DD",9002313.02,9002313.1001,440,0) PROFESSIONAL SERVICE CODE^F^^0;3^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.1001,440,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.1001,440,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.1001,440,21,1,0) Code identifying the type of utilization conflict detected or the reason "^DD",9002313.02,9002313.1001,440,21,2,0) for the pharmacist's professional service. NCPDP standard field 440-E5. "^DD",9002313.02,9002313.1001,440,23,0) ^^3^3^3080104^ "^DD",9002313.02,9002313.1001,440,23,1,0) If the pharmacist spoke with the patient as a result of a conflict code "^DD",9002313.02,9002313.1001,440,23,2,0) being transmitted on a prescription, the field would reflect P0. "^DD",9002313.02,9002313.1001,440,23,3,0) REQUEST DUR/PPS SEGMENT. "^DD",9002313.02,9002313.1001,440,"DT") 3080104 "^DD",9002313.02,9002313.1001,441,0) RESULT OF SERVICE CODE^F^^0;4^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.1001,441,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.1001,441,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.1001,441,21,1,0) Action taken by a pharmacist in response to a conflict or the result of a "^DD",9002313.02,9002313.1001,441,21,2,0) pharmacist's professional service. NCPDP standard field 441-E6. "^DD",9002313.02,9002313.1001,441,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.1001,441,23,1,0) REQUEST DUR/PPS SEGMENT. "^DD",9002313.02,9002313.1001,441,"DT") 3080104 "^DD",9002313.02,9002313.1001,474,0) DUR/PPS LEVEL OF EFFORT^F^^0;5^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.1001,474,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.1001,474,21,0) ^^3^3^3080104^ "^DD",9002313.02,9002313.1001,474,21,1,0) Code indicating the level of effort as determined by the complexity of "^DD",9002313.02,9002313.1001,474,21,2,0) decision making or resources utilized by a pharmacist to perform a "^DD",9002313.02,9002313.1001,474,21,3,0) professional service. NCPDP standard field 474-8E. "^DD",9002313.02,9002313.1001,474,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.1001,474,23,1,0) REQUEST DUR/PPS SEGMENT. "^DD",9002313.02,9002313.1001,474,"DT") 3210331 "^DD",9002313.02,9002313.1001,475,0) DUR/DUE CO-AGENT ID QUALIFIER^F^^0;6^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.1001,475,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.1001,475,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.1001,475,21,1,0) Code qualifying the value in DUR Co-Agent ID (476-H6). NCPDP standard "^DD",9002313.02,9002313.1001,475,21,2,0) field 475-J9. "^DD",9002313.02,9002313.1001,475,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.1001,475,23,1,0) REQUEST DUR/PPS SEGMENT. "^DD",9002313.02,9002313.1001,475,"DT") 3210331 "^DD",9002313.02,9002313.1001,476,0) DUR/DUE CO-AGENT ID^F^^0;7^K:$L(X)>21!($L(X)<21) X "^DD",9002313.02,9002313.1001,476,3) Answer must be 21 characters in length "^DD",9002313.02,9002313.1001,476,21,0) ^^3^3^3080104^ "^DD",9002313.02,9002313.1001,476,21,1,0) Identifies the co-existing agent contributing to the DUR event (drug or "^DD",9002313.02,9002313.1001,476,21,2,0) disease conflicting with the prescribed drug or prompting pharmacist "^DD",9002313.02,9002313.1001,476,21,3,0) professional service). NCPDP standard field 476-H6. "^DD",9002313.02,9002313.1001,476,23,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.1001,476,23,1,0) Qualified by DUR Co-Agent ID Qualifier (475-J9). "^DD",9002313.02,9002313.1001,476,23,2,0) REQUEST DUR/PPS SEGMENT. "^DD",9002313.02,9002313.1001,476,"DT") 3210331 "^DD",9002313.02,9002313.201459,0) PROCEDURE MODIFIER CODE SUB-FIELD^^.01^1 "^DD",9002313.02,9002313.201459,0,"DT") 3080104 "^DD",9002313.02,9002313.201459,0,"IX","B",9002313.201459,.01) "^DD",9002313.02,9002313.201459,0,"NM","PROCEDURE MODIFIER CODE") "^DD",9002313.02,9002313.201459,0,"UP") 9002313.0201 "^DD",9002313.02,9002313.201459,.01,0) PROCEDURE MODIFIER CODE^F^^0;1^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.201459,.01,1,0) ^.1 "^DD",9002313.02,9002313.201459,.01,1,1,0) 9002313.201459^B "^DD",9002313.02,9002313.201459,.01,1,1,1) S ^BPSC(DA(2),400,DA(1),459,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.201459,.01,1,1,2) K ^BPSC(DA(2),400,DA(1),459,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.201459,.01,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.201459,.01,21,0) ^^2^2^3080104^ "^DD",9002313.02,9002313.201459,.01,21,1,0) Identifies special circumstances related to the performance of the "^DD",9002313.02,9002313.201459,.01,21,2,0) service. NCPDP standard field 459-ER. "^DD",9002313.02,9002313.201459,.01,23,0) ^^1^1^3080104^ "^DD",9002313.02,9002313.201459,.01,23,1,0) REQUEST CLAIM SEGMENT. "^DD",9002313.02,9002313.201459,.01,"DT") 3080104 "^DD",9002313.02,9002313.29999,0) RAW DATA SENT SUB-FIELD^^.01^1 "^DD",9002313.02,9002313.29999,0,"DT") 3000830 "^DD",9002313.02,9002313.29999,0,"NM","RAW DATA SENT") "^DD",9002313.02,9002313.29999,0,"UP") 9002313.02 "^DD",9002313.02,9002313.29999,.01,0) RAW DATA SENT^WL^^0;1^Q "^DD",9002313.02,9002313.29999,.01,21,0) ^^4^4^3031124^^ "^DD",9002313.02,9002313.29999,.01,21,1,0) A copy of the raw packet is saved here. "^DD",9002313.02,9002313.29999,.01,21,2,0) It's intended to be of help in times of dispute. "^DD",9002313.02,9002313.29999,.01,21,3,0) This field could be winnowed before the rest of the 9002313.02 is winnowed. "^DD",9002313.02,9002313.29999,.01,21,4,0) For instance, it might make sense to only keep a month of these around. "^DD",9002313.02,9002313.29999,.01,"DT") 3031124 "^DD",9002313.02,9002313.401342,0) OTHER PAYER AMT PAID QUALIFIER SUB-FIELD^^431^2 "^DD",9002313.02,9002313.401342,0,"DT") 3080103 "^DD",9002313.02,9002313.401342,0,"IX","B",9002313.401342,.01) "^DD",9002313.02,9002313.401342,0,"NM","OTHER PAYER AMT PAID QUALIFIER") "^DD",9002313.02,9002313.401342,0,"UP") 9002313.0401 "^DD",9002313.02,9002313.401342,.01,0) OTHER PAYER AMT PAID QUALIFIER^F^^0;1^K:$L(X)>4!($L(X)<4) X "^DD",9002313.02,9002313.401342,.01,1,0) ^.1 "^DD",9002313.02,9002313.401342,.01,1,1,0) 9002313.401342^B "^DD",9002313.02,9002313.401342,.01,1,1,1) S ^BPSC(DA(3),400,DA(2),337,DA(1),1,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.401342,.01,1,1,2) K ^BPSC(DA(3),400,DA(2),337,DA(1),1,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.401342,.01,3) Answer must be 4 characters in length "^DD",9002313.02,9002313.401342,.01,21,0) ^^2^2^3080604^ "^DD",9002313.02,9002313.401342,.01,21,1,0) Code qualifying the Other Payer Amount Paid (431-DV). NCPDP standard "^DD",9002313.02,9002313.401342,.01,21,2,0) field 342-HC. "^DD",9002313.02,9002313.401342,.01,23,0) ^^1^1^3080604^^ "^DD",9002313.02,9002313.401342,.01,23,1,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.401342,.01,"DT") 3080604 "^DD",9002313.02,9002313.401342,431,0) OTHER PAYER AMOUNT PAID^F^^0;2^K:$L(X)>10!($L(X)<10) X "^DD",9002313.02,9002313.401342,431,3) Answer must be 10 characters in length "^DD",9002313.02,9002313.401342,431,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.401342,431,21,1,0) Amount of any payment known by the pharmacy from other sources (including "^DD",9002313.02,9002313.401342,431,21,2,0) coupons). NCPDP standard field 431-DV. "^DD",9002313.02,9002313.401342,431,23,0) ^.001^6^6^3101020^^^^ "^DD",9002313.02,9002313.401342,431,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.401342,431,23,2,0) "^DD",9002313.02,9002313.401342,431,23,3,0) Examples: If the other payer amount paid is $32.56, this field would "^DD",9002313.02,9002313.401342,431,23,4,0) reflect: 325F. "^DD",9002313.02,9002313.401342,431,23,5,0) "^DD",9002313.02,9002313.401342,431,23,6,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.401342,431,"DT") 3080103 "^DD",9002313.02,9002313.401353,0) OTHER PAYER-PATIENT RESP MLTPL SUB-FIELD^^352^3 "^DD",9002313.02,9002313.401353,0,"DT") 3210331 "^DD",9002313.02,9002313.401353,0,"IX","B",9002313.401353,.01) "^DD",9002313.02,9002313.401353,0,"NM","OTHER PAYER-PATIENT RESP MLTPL") "^DD",9002313.02,9002313.401353,0,"UP") 9002313.0401 "^DD",9002313.02,9002313.401353,.01,0) OTHER PAYER-PATIENT COUNTER^NJ2,0^^0;1^K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X "^DD",9002313.02,9002313.401353,.01,1,0) ^.1 "^DD",9002313.02,9002313.401353,.01,1,1,0) 9002313.401353^B "^DD",9002313.02,9002313.401353,.01,1,1,1) S ^BPSC(DA(3),400,DA(2),337,DA(1),3,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.401353,.01,1,1,2) K ^BPSC(DA(3),400,DA(2),337,DA(1),3,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.401353,.01,3) Type a number between 1 and 99, 0 decimal digits. "^DD",9002313.02,9002313.401353,.01,21,0) ^.001^1^1^3101020^^ "^DD",9002313.02,9002313.401353,.01,21,1,0) This is an integer counter incremented by software. "^DD",9002313.02,9002313.401353,.01,"DT") 3100901 "^DD",9002313.02,9002313.401353,351,0) OTHER PAYER-PAT RESP AMT QLFR^F^^0;2^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.401353,351,.1) OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT QUALIFIER "^DD",9002313.02,9002313.401353,351,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.401353,351,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.401353,351,21,1,0) This is used to store NCPDP field 351-NP (Other Payer-Patient Responsibility Amount Qualifier), "^DD",9002313.02,9002313.401353,351,21,2,0) which is defined as "Code qualifying the Other Payer-Patient Responsibility Amount (352-NQ)." "^DD",9002313.02,9002313.401353,351,23,0) ^^3^3^3100901^ "^DD",9002313.02,9002313.401353,351,23,1,0) Comments: This field is submitted by the pharmacist for the purpose of qualifying "^DD",9002313.02,9002313.401353,351,23,2,0) the entry in the Other Payer-Patient Responsibility Amount field. "^DD",9002313.02,9002313.401353,351,23,3,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.401353,351,"DT") 3210331 "^DD",9002313.02,9002313.401353,352,0) OTHER PAYER-PAT RESP AMOUNT^F^^0;3^K:$L(X)>12!($L(X)<1) X "^DD",9002313.02,9002313.401353,352,.1) OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT "^DD",9002313.02,9002313.401353,352,3) Answer must be 1-12 characters. "^DD",9002313.02,9002313.401353,352,21,0) ^.001^2^2^3100901^^ "^DD",9002313.02,9002313.401353,352,21,1,0) This is used to store NCPDP field 352-NQ (Other Payer-Patient Responsibility Amount), "^DD",9002313.02,9002313.401353,352,21,2,0) which is defined as "The patient's cost share from a previous payer." "^DD",9002313.02,9002313.401353,352,23,0) ^^1^1^3100901^ "^DD",9002313.02,9002313.401353,352,23,1,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.401353,352,"DT") 3210331 "^DD",9002313.02,9002313.401392,0) BENEFIT STAGE MLTPL SUB-FIELD^^394^3 "^DD",9002313.02,9002313.401392,0,"DT") 3100901 "^DD",9002313.02,9002313.401392,0,"IX","B",9002313.401392,.01) "^DD",9002313.02,9002313.401392,0,"NM","BENEFIT STAGE MLTPL") "^DD",9002313.02,9002313.401392,0,"UP") 9002313.0401 "^DD",9002313.02,9002313.401392,.01,0) BENEFIT STAGE COUNTER^NJ2,0^^0;1^K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X "^DD",9002313.02,9002313.401392,.01,1,0) ^.1 "^DD",9002313.02,9002313.401392,.01,1,1,0) 9002313.401392^B "^DD",9002313.02,9002313.401392,.01,1,1,1) S ^BPSC(DA(3),400,DA(2),337,DA(1),4,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.401392,.01,1,1,2) K ^BPSC(DA(3),400,DA(2),337,DA(1),4,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.401392,.01,3) Type a number between 1 and 99, 0 decimal digits. "^DD",9002313.02,9002313.401392,.01,21,0) ^^1^1^3101021^ "^DD",9002313.02,9002313.401392,.01,21,1,0) This is a sequential counter incremented by software. "^DD",9002313.02,9002313.401392,.01,"DT") 3100901 "^DD",9002313.02,9002313.401392,393,0) BENEFIT STAGE QUALIFIER^F^^0;2^K:$L(X)>4!($L(X)<1) X "^DD",9002313.02,9002313.401392,393,3) Answer must be 1-4 characters. "^DD",9002313.02,9002313.401392,393,21,0) ^.001^2^2^3101014^^^ "^DD",9002313.02,9002313.401392,393,21,1,0) This is used to store NCPDP field 393-MV (Benefit Stage Qualifier), "^DD",9002313.02,9002313.401392,393,21,2,0) which is defined as "Code qualifying the Benefit Stage Amount (394-MW)." "^DD",9002313.02,9002313.401392,393,23,0) ^.001^2^2^3101014^^ "^DD",9002313.02,9002313.401392,393,23,1,0) Comments: Qualifies Benefit Stage Amount (392-MW). "^DD",9002313.02,9002313.401392,393,23,2,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.401392,393,"DT") 3100901 "^DD",9002313.02,9002313.401392,394,0) BENEFIT STAGE AMOUNT^F^^0;3^K:$L(X)>10!($L(X)<1) X "^DD",9002313.02,9002313.401392,394,3) Answer must be 1-10 characters. "^DD",9002313.02,9002313.401392,394,21,0) ^.001^2^2^3101014^^^ "^DD",9002313.02,9002313.401392,394,21,1,0) This is used to store NCPDP field 394-MW (Benefit Stage Amount), "^DD",9002313.02,9002313.401392,394,21,2,0) which is defined as "The amount of claim allocated to the Medicare stage identified by the Benefit Stage Qualifier (393-MV)." "^DD",9002313.02,9002313.401392,394,23,0) ^.001^3^3^3101014^^ "^DD",9002313.02,9002313.401392,394,23,1,0) Format=s$$$$$$cc "^DD",9002313.02,9002313.401392,394,23,2,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.401392,394,23,3,0) RESPONSE PRICING SEGMENT. "^DD",9002313.02,9002313.401392,394,"DT") 3100901 "^DD",9002313.02,9002313.401472,0) OTHER PAYER REJECT CODE SUB-FIELD^^.01^1 "^DD",9002313.02,9002313.401472,0,"DT") 3080103 "^DD",9002313.02,9002313.401472,0,"IX","B",9002313.401472,.01) "^DD",9002313.02,9002313.401472,0,"NM","OTHER PAYER REJECT CODE") "^DD",9002313.02,9002313.401472,0,"UP") 9002313.0401 "^DD",9002313.02,9002313.401472,.01,0) OTHER PAYER REJECT CODE^F^^0;1^K:$L(X)>5!($L(X)<5) X "^DD",9002313.02,9002313.401472,.01,1,0) ^.1 "^DD",9002313.02,9002313.401472,.01,1,1,0) 9002313.401472^B "^DD",9002313.02,9002313.401472,.01,1,1,1) S ^BPSC(DA(3),400,DA(2),337,DA(1),2,"B",$E(X,1,30),DA)="" "^DD",9002313.02,9002313.401472,.01,1,1,2) K ^BPSC(DA(3),400,DA(2),337,DA(1),2,"B",$E(X,1,30),DA) "^DD",9002313.02,9002313.401472,.01,3) Answer must be 5 characters in length "^DD",9002313.02,9002313.401472,.01,21,0) ^^2^2^3080103^ "^DD",9002313.02,9002313.401472,.01,21,1,0) The error encountered by the previous "Other Payer" in Reject Code "^DD",9002313.02,9002313.401472,.01,21,2,0) (511-FB). NCPDP standard field 472-6E. "^DD",9002313.02,9002313.401472,.01,23,0) ^.001^1^1^3101020^^^^ "^DD",9002313.02,9002313.401472,.01,23,1,0) REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. "^DD",9002313.02,9002313.401472,.01,"DT") 3080103 "^DD",9002313.91,9002313.91,0) FIELD^^3^15 "^DD",9002313.91,9002313.91,0,"DDA") N "^DD",9002313.91,9002313.91,0,"DT") 3181210 "^DD",9002313.91,9002313.91,0,"ID",.03) W " ",$P(^(0),U,3) "^DD",9002313.91,9002313.91,0,"IX","AC",9002313.91,2) "^DD",9002313.91,9002313.91,0,"IX","AD",9002313.91,3) "^DD",9002313.91,9002313.91,0,"IX","B",9002313.91,.01) "^DD",9002313.91,9002313.91,0,"IX","C",9002313.91,.03) "^DD",9002313.91,9002313.91,0,"IX","D",9002313.91,.06) "^DD",9002313.91,9002313.91,0,"NM","BPS NCPDP FIELD DEFS") "^DD",9002313.91,9002313.91,0,"PT",9002313.311,.01) "^DD",9002313.91,9002313.91,0,"PT",9002313.3121,.01) "^DD",9002313.91,9002313.91,0,"PT",9002313.5111,.01) "^DD",9002313.91,9002313.91,0,"PT",9002313.5112,.01) "^DD",9002313.91,9002313.91,0,"PT",9002313.9205,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9206,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9207,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9208,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9209,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.921,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9213,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9214,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9215,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9216,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9217,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9218,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9219,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.922,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9223,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9224,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9225,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9227,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9228,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.9229,.02) "^DD",9002313.91,9002313.91,0,"PT",9002313.923,.02) "^DD",9002313.91,9002313.91,0,"VRPK") BPS "^DD",9002313.91,9002313.91,.01,0) NCPDP FIELD NUMBER^RFX^^0;1^K:$L(X)>6!($L(X)<3) X "^DD",9002313.91,9002313.91,.01,1,0) ^.1 "^DD",9002313.91,9002313.91,.01,1,1,0) 9002313.91^B "^DD",9002313.91,9002313.91,.01,1,1,1) S ^BPSF(9002313.91,"B",$E(X,1,30),DA)="" "^DD",9002313.91,9002313.91,.01,1,1,2) K ^BPSF(9002313.91,"B",$E(X,1,30),DA) "^DD",9002313.91,9002313.91,.01,3) Enter the NCPDP field number (either 0-997, 2 Decimal Digits or 3 Alphanumerics). "^DD",9002313.91,9002313.91,.01,21,0) ^^1^1^3101014^ "^DD",9002313.91,9002313.91,.01,21,1,0) This is the NCPDP field number as specified in the NCPDP data dictionary. "^DD",9002313.91,9002313.91,.01,"DT") 3170227 "^DD",9002313.91,9002313.91,.03,0) NAME^F^^0;3^K:$L(X)>30!($L(X)<3) X "^DD",9002313.91,9002313.91,.03,1,0) ^.1 "^DD",9002313.91,9002313.91,.03,1,1,0) 9002313.91^C "^DD",9002313.91,9002313.91,.03,1,1,1) S ^BPSF(9002313.91,"C",$E(X,1,30),DA)="" "^DD",9002313.91,9002313.91,.03,1,1,2) K ^BPSF(9002313.91,"C",$E(X,1,30),DA) "^DD",9002313.91,9002313.91,.03,1,1,"DT") 3001007 "^DD",9002313.91,9002313.91,.03,3) Answer must be 3-30 characters in length. "^DD",9002313.91,9002313.91,.03,21,0) ^^2^2^3071227^ "^DD",9002313.91,9002313.91,.03,21,1,0) Descriptive name the tells what the field is within the pharmacy "^DD",9002313.91,9002313.91,.03,21,2,0) environment. "^DD",9002313.91,9002313.91,.03,"DT") 3071227 "^DD",9002313.91,9002313.91,.04,0) FORMAT^S^N:NUMERIC;A/N:ALPHA/NUMERIC;D:SIGNED NUMERIC;^0;4^Q "^DD",9002313.91,9002313.91,.04,3) Enter the field's format type. "^DD",9002313.91,9002313.91,.04,21,0) ^^1^1^3071227^ "^DD",9002313.91,9002313.91,.04,21,1,0) This is the format of the field used within the NCPDP standard. "^DD",9002313.91,9002313.91,.04,"DT") 3071227 "^DD",9002313.91,9002313.91,.06,0) ID^F^^5;1^K:$L(X)>2!($L(X)<2) X "^DD",9002313.91,9002313.91,.06,1,0) ^.1 "^DD",9002313.91,9002313.91,.06,1,1,0) 9002313.91^D "^DD",9002313.91,9002313.91,.06,1,1,1) S ^BPSF(9002313.91,"D",$E(X,1,30),DA)="" "^DD",9002313.91,9002313.91,.06,1,1,2) K ^BPSF(9002313.91,"D",$E(X,1,30),DA) "^DD",9002313.91,9002313.91,.06,1,1,"%D",0) ^^3^3^3020807^ "^DD",9002313.91,9002313.91,.06,1,1,"%D",1,0) Cross reference of the 5.1 Field ID. This cross reference will be used in "^DD",9002313.91,9002313.91,.06,1,1,"%D",2,0) the processing of the response as a means of translating the value to a "^DD",9002313.91,9002313.91,.06,1,1,"%D",3,0) field number. "^DD",9002313.91,9002313.91,.06,1,1,"DT") 3020807 "^DD",9002313.91,9002313.91,.06,3) Answer must be 2 characters in length. "^DD",9002313.91,9002313.91,.06,21,0) ^^3^3^3071227^ "^DD",9002313.91,9002313.91,.06,21,1,0) The same as the .02 field, but for specific use when creating 5.1 "^DD",9002313.91,9002313.91,.06,21,2,0) claims. The 5.1 fields were separated because 3.x and 5.1 claims were "^DD",9002313.91,9002313.91,.06,21,3,0) being submitted concurrently. "^DD",9002313.91,9002313.91,.06,"DT") 3071227 "^DD",9002313.91,9002313.91,.07,0) LENGTH^NJ4,0^^5;2^K:+X'=X!(X>9999)!(X<1)!(X?.E1"."1.N) X "^DD",9002313.91,9002313.91,.07,3) Type a number between 1 and 9999, 0 Decimal Digits "^DD",9002313.91,9002313.91,.07,21,0) ^^1^1^3040121^ "^DD",9002313.91,9002313.91,.07,21,1,0) Length of the field from the 5.1 NCPDP standard. "^DD",9002313.91,9002313.91,.07,"DT") 3071227 "^DD",9002313.91,9002313.91,.08,0) D0 LENGTH^NJ3,0^^0;8^K:+X'=X!(X>999)!(X<1)!(X?.E1"."1N.N) X "^DD",9002313.91,9002313.91,.08,3) Enter the length of the NCPDP field per the NCPDP data dictionary (1-999). "^DD",9002313.91,9002313.91,.08,21,0) ^^2^2^3101014^ "^DD",9002313.91,9002313.91,.08,21,1,0) This is the NCPDP length as specified in the NCPDP Telecommunication "^DD",9002313.91,9002313.91,.08,21,2,0) Standard version D.0 data dictionary. "^DD",9002313.91,9002313.91,.08,"DT") 3101014 "^DD",9002313.91,9002313.91,.09,0) D0 FORMAT^S^N:NUMERIC;A/N:ALPHANUMERIC;D:SIGNED NUMERIC;^0;9^Q "^DD",9002313.91,9002313.91,.09,3) Enter the data type for the field based on the NCPDP data dictionary. "^DD",9002313.91,9002313.91,.09,21,0) ^^2^2^3101014^ "^DD",9002313.91,9002313.91,.09,21,1,0) This is the NCPDP data type as specified in the NCPDP Telecommunication "^DD",9002313.91,9002313.91,.09,21,2,0) Standard version D.0 data dictionary. "^DD",9002313.91,9002313.91,.09,"DT") 3101014 "^DD",9002313.91,9002313.91,1,0) VISTA FIELD NUMBER^NJ4,0^^5;3^K:+X'=X!(X>2999)!(X<1001)!(X?.E1"."1.N) X "^DD",9002313.91,9002313.91,1,3) Type a number between 1001 and 2999, 0 decimal digits. "^DD",9002313.91,9002313.91,1,21,0) ^^5^5^3130424^ "^DD",9002313.91,9002313.91,1,21,1,0) This is the VistA field number used in BPS CLAIMS file #9002313.02 and BPS "^DD",9002313.91,9002313.91,1,21,2,0) RESPONSES file #9002313.03. Only used for NCPDP numbers where the first "^DD",9002313.91,9002313.91,1,21,3,0) piece of the NCPDP number is non-numeric. "^DD",9002313.91,9002313.91,1,21,4,0) "^DD",9002313.91,9002313.91,1,21,5,0) For example, NCPDP field B04-BT - Next Available Fill Date. "^DD",9002313.91,9002313.91,1,"DT") 3130424 "^DD",9002313.91,9002313.91,1.01,0) STANDARD NCPDP FIELD NAME^F^^1;1^K:$L(X)>100!($L(X)<1) X "^DD",9002313.91,9002313.91,1.01,3) Enter the full NCPDP field name based on the NCPDP data dictionary (1-100 characters). "^DD",9002313.91,9002313.91,1.01,21,0) ^^3^3^3200904^ "^DD",9002313.91,9002313.91,1.01,21,1,0) This field is used for those NCPDP field names that were too long to fit "^DD",9002313.91,9002313.91,1.01,21,2,0) in the NAME (#.03) field. For those fields, this field will "^DD",9002313.91,9002313.91,1.01,21,3,0) have the full NCPDP field name. "^DD",9002313.91,9002313.91,1.01,"DT") 3110706 "^DD",9002313.91,9002313.91,2,0) REQUEST SEGMENT^P9002313.9'^BPSF(9002313.9,^5;4^Q "^DD",9002313.91,9002313.91,2,1,0) ^.1 "^DD",9002313.91,9002313.91,2,1,1,0) 9002313.91^AC "^DD",9002313.91,9002313.91,2,1,1,1) S ^BPSF(9002313.91,"AC",$E(X,1,30),DA)="" "^DD",9002313.91,9002313.91,2,1,1,2) K ^BPSF(9002313.91,"AC",$E(X,1,30),DA) "^DD",9002313.91,9002313.91,2,1,1,"%D",0) ^^1^1^3171102^ "^DD",9002313.91,9002313.91,2,1,1,"%D",1,0) This cross-reference lists each field by its REQUEST SEGMENT. "^DD",9002313.91,9002313.91,2,1,1,"DT") 3171102 "^DD",9002313.91,9002313.91,2,3) Select the Request Segment which this field would appear on. "^DD",9002313.91,9002313.91,2,21,0) ^^3^3^3171024^ "^DD",9002313.91,9002313.91,2,21,1,0) This data field indicates the segment of a claim request on which this "^DD",9002313.91,9002313.91,2,21,2,0) NCPDP field would appear. If this NCPDP field appears only on the "^DD",9002313.91,9002313.91,2,21,3,0) incoming response, then this field would remain blank. "^DD",9002313.91,9002313.91,2,"DT") 3171102 "^DD",9002313.91,9002313.91,3,0) RESPONSE SEGMENT^P9002313.9'^BPSF(9002313.9,^5;5^Q "^DD",9002313.91,9002313.91,3,1,0) ^.1 "^DD",9002313.91,9002313.91,3,1,1,0) 9002313.91^AD "^DD",9002313.91,9002313.91,3,1,1,1) S ^BPSF(9002313.91,"AD",$E(X,1,30),DA)="" "^DD",9002313.91,9002313.91,3,1,1,2) K ^BPSF(9002313.91,"AD",$E(X,1,30),DA) "^DD",9002313.91,9002313.91,3,1,1,"%D",0) ^^1^1^3171102^ "^DD",9002313.91,9002313.91,3,1,1,"%D",1,0) This cross-reference lists each field by its RESPONSE SEGMENT. "^DD",9002313.91,9002313.91,3,1,1,"DT") 3171102 "^DD",9002313.91,9002313.91,3,3) Select the Response Segment which this field would appear on. "^DD",9002313.91,9002313.91,3,21,0) ^^3^3^3171024^ "^DD",9002313.91,9002313.91,3,21,1,0) This data field indicates the segment of a claim response on which this "^DD",9002313.91,9002313.91,3,21,2,0) NCPDP field would appear. If this NCPDP field appears only on the "^DD",9002313.91,9002313.91,3,21,3,0) outgoing claim request, then this field would remain blank. "^DD",9002313.91,9002313.91,3,"DT") 3171102 "^DD",9002313.91,9002313.91,10,0) GET CODE^9002313.9101^^10;0 "^DD",9002313.91,9002313.91,10,3) Enter the M code to extract the data for this field. "^DD",9002313.91,9002313.91,10,9) @ "^DD",9002313.91,9002313.91,10,21,0) ^.001^2^2^3101001^^ "^DD",9002313.91,9002313.91,10,21,1,0) M code that tells the BPS system where to find the "^DD",9002313.91,9002313.91,10,21,2,0) particular piece of data for this field. "^DD",9002313.91,9002313.91,10,"DT") 3071227 "^DD",9002313.91,9002313.91,20,0) D0 FORMAT CODE^9002313.9102^^20;0 "^DD",9002313.91,9002313.91,20,9) @ "^DD",9002313.91,9002313.91,20,21,0) ^^4^4^3101014^ "^DD",9002313.91,9002313.91,20,21,1,0) This field holds the M code used to format the data according to the "^DD",9002313.91,9002313.91,20,21,2,0) specifications of the NCPDP Telecommunication Standard version D.0 data "^DD",9002313.91,9002313.91,20,21,3,0) dictionary. For instance, alphanumeric fields are right-padded with "^DD",9002313.91,9002313.91,20,21,4,0) spaces up to the length of the specified by the NCPDP standard. "^DD",9002313.91,9002313.91,20,"DT") 3101005 "^DD",9002313.91,9002313.91,30,0) SET CODE^9002313.9103^^30;0 "^DD",9002313.91,9002313.91,30,3) Enter the M code for the field's data storage. "^DD",9002313.91,9002313.91,30,9) @ "^DD",9002313.91,9002313.91,30,21,0) ^^1^1^3040326^ "^DD",9002313.91,9002313.91,30,21,1,0) M code to store the data in the appropriate segment within the claim. "^DD",9002313.91,9002313.91,30,"DT") 3071227 "^DD",9002313.91,9002313.91,40,0) FORMAT CODE^9002313.9104^^25;0 "^DD",9002313.91,9002313.91,40,3) Enter the M code to format the data in NCPDP format. "^DD",9002313.91,9002313.91,40,9) @ "^DD",9002313.91,9002313.91,40,21,0) ^^2^2^3071227^ "^DD",9002313.91,9002313.91,40,21,1,0) M code to format the data before storing it in the claim. 5.1 was "^DD",9002313.91,9002313.91,40,21,2,0) separate because 3.2 and 5.1 claims were being submitted at the same time. "^DD",9002313.91,9002313.91,40,"DT") 3071227 "^DD",9002313.91,9002313.9101,0) GET CODE SUB-FIELD^^.01^1 "^DD",9002313.91,9002313.9101,0,"DT") 3071227 "^DD",9002313.91,9002313.9101,0,"NM","GET CODE") "^DD",9002313.91,9002313.9101,0,"UP") 9002313.91 "^DD",9002313.91,9002313.9101,.01,0) GET CODE^WL^^0;1^Q "^DD",9002313.91,9002313.9101,.01,3) Enter the M code to extract the data for this field. "^DD",9002313.91,9002313.9101,.01,9) @ "^DD",9002313.91,9002313.9101,.01,"DT") 3071227 "^DD",9002313.91,9002313.9102,0) D0 FORMAT CODE SUB-FIELD^^.01^1 "^DD",9002313.91,9002313.9102,0,"DT") 3100721 "^DD",9002313.91,9002313.9102,0,"NM","D0 FORMAT CODE") "^DD",9002313.91,9002313.9102,0,"UP") 9002313.91 "^DD",9002313.91,9002313.9102,.01,0) D0 FORMAT CODE^WLx^^0;1^Q "^DD",9002313.91,9002313.9102,.01,"DT") 3101014 "^DD",9002313.91,9002313.9103,0) SET CODE SUB-FIELD^^.01^1 "^DD",9002313.91,9002313.9103,0,"DT") 2950420 "^DD",9002313.91,9002313.9103,0,"NM","SET CODE") "^DD",9002313.91,9002313.9103,0,"UP") 9002313.91 "^DD",9002313.91,9002313.9103,.01,0) SET CODE^WL^^0;1^Q "^DD",9002313.91,9002313.9103,.01,3) Enter the M code for the field's data storage. "^DD",9002313.91,9002313.9103,.01,9) @ "^DD",9002313.91,9002313.9103,.01,"DT") 3071227 "^DD",9002313.91,9002313.9104,0) FORMAT CODE SUB-FIELD^^.01^1 "^DD",9002313.91,9002313.9104,0,"DT") 3020724 "^DD",9002313.91,9002313.9104,0,"NM","FORMAT CODE") "^DD",9002313.91,9002313.9104,0,"UP") 9002313.91 "^DD",9002313.91,9002313.9104,.01,0) FORMAT CODE^WL^^0;1^Q "^DD",9002313.91,9002313.9104,.01,3) Enter the M code to format the data in NCPDP format. "^DD",9002313.91,9002313.9104,.01,9) @ "^DD",9002313.91,9002313.9104,.01,"DT") 3071227 "^DIC",9002313.02,9002313.02,0) BPS CLAIMS^9002313.02 "^DIC",9002313.02,9002313.02,0,"GL") ^BPSC( "^DIC",9002313.02,9002313.02,"%",0) ^1.005^^0 "^DIC",9002313.02,9002313.02,"%","B","ABSP",1) "^DIC",9002313.02,9002313.02,"%D",0) ^^16^16^3100930^ "^DIC",9002313.02,9002313.02,"%D",1,0) Intermediate form of transmissions. Fields are stored in formatted form. "^DIC",9002313.02,9002313.02,"%D",2,0) Raw packet is also stored. "^DIC",9002313.02,9002313.02,"%D",3,0) "^DIC",9002313.02,9002313.02,"%D",4,0) Most fields are in Free Text format to accommodate NCPDP Standard "^DIC",9002313.02,9002313.02,"%D",5,0) formatting criteria and required field lengths. Fields other than those "^DIC",9002313.02,9002313.02,"%D",6,0) with decimals in the number correlate directly to the field numbers "^DIC",9002313.02,9002313.02,"%D",7,0) supplied in the NCPDP Data Dictionary. "^DIC",9002313.02,9002313.02,"%D",8,0) "^DIC",9002313.02,9002313.02,"%D",9,0) While many of the fields in this file indicate coded values, they are "^DIC",9002313.02,9002313.02,"%D",10,0) NCPDP coded values preceded by the NCPDP field identifier to be used "^DIC",9002313.02,9002313.02,"%D",11,0) in the NCPDP transmission. Example: Compound Code is either a 1 or 0. "^DIC",9002313.02,9002313.02,"%D",12,0) The NCPDP field identifier for 'Compound Code' is 'D6'. The field length "^DIC",9002313.02,9002313.02,"%D",13,0) is 3 thereby allowing the identifier for that field to be included in the "^DIC",9002313.02,9002313.02,"%D",14,0) data stored in that field. So, 'D61' is stored for that field. "^DIC",9002313.02,9002313.02,"%D",15,0) "^DIC",9002313.02,9002313.02,"%D",16,0) Per VHA Directive 2004-038, this file definition should not be modified. "^DIC",9002313.02,"B","BPS CLAIMS",9002313.02) "^DIC",9002313.91,9002313.91,0) BPS NCPDP FIELD DEFS^9002313.91 "^DIC",9002313.91,9002313.91,0,"GL") ^BPSF(9002313.91, "^DIC",9002313.91,9002313.91,"%",0) ^1.005^^0 "^DIC",9002313.91,9002313.91,"%","B","ABSP",1) "^DIC",9002313.91,9002313.91,"%D",0) ^1.001^4^4^3100925^^^^ "^DIC",9002313.91,9002313.91,"%D",1,0) The NCPDP Data Dictionary Individual fields which combine into formatted "^DIC",9002313.91,9002313.91,"%D",2,0) packets. "^DIC",9002313.91,9002313.91,"%D",3,0) "^DIC",9002313.91,9002313.91,"%D",4,0) Per VHA Directive 2004-038, this file definition should not be modified. "^DIC",9002313.91,"B","BPS NCPDP FIELD DEFS",9002313.91) **INSTALL NAME** PSO*7.0*648 "BLD",12484,0) PSO*7.0*648^OUTPATIENT PHARMACY^0^3220613^y "BLD",12484,4,0) ^9.64PA^52^1 "BLD",12484,4,52,0) 52 "BLD",12484,4,52,2,0) ^9.641^52.1^1 "BLD",12484,4,52,2,52.1,0) REFILL (sub-file) "BLD",12484,4,52,2,52.1,1,0) ^9.6411^98^1 "BLD",12484,4,52,2,52.1,1,98,0) BYPASS 3/4 DAY SUPPLY LOGIC "BLD",12484,4,52,222) y^y^p^^^^n^^n "BLD",12484,4,52,224) "BLD",12484,4,"APDD",52,52.1) "BLD",12484,4,"APDD",52,52.1,98) "BLD",12484,4,"B",52,52) "BLD",12484,6) 5 "BLD",12484,6.3) 15 "BLD",12484,"ABPKG") n "BLD",12484,"KRN",0) ^9.67PA^1.5^25 "BLD",12484,"KRN",.4,0) .4 "BLD",12484,"KRN",.401,0) .401 "BLD",12484,"KRN",.402,0) .402 "BLD",12484,"KRN",.403,0) .403 "BLD",12484,"KRN",.5,0) .5 "BLD",12484,"KRN",.84,0) .84 "BLD",12484,"KRN",1.5,0) 1.5 "BLD",12484,"KRN",1.6,0) 1.6 "BLD",12484,"KRN",1.61,0) 1.61 "BLD",12484,"KRN",1.62,0) 1.62 "BLD",12484,"KRN",3.6,0) 3.6 "BLD",12484,"KRN",3.8,0) 3.8 "BLD",12484,"KRN",9.2,0) 9.2 "BLD",12484,"KRN",9.8,0) 9.8 "BLD",12484,"KRN",9.8,"NM",0) ^9.68A^3^3 "BLD",12484,"KRN",9.8,"NM",1,0) PSOREJP1^^0^B203439370 "BLD",12484,"KRN",9.8,"NM",2,0) PSOREJU4^^0^B96109069 "BLD",12484,"KRN",9.8,"NM",3,0) PSOBPSU4^^0^B51517974 "BLD",12484,"KRN",9.8,"NM","B","PSOBPSU4",3) "BLD",12484,"KRN",9.8,"NM","B","PSOREJP1",1) "BLD",12484,"KRN",9.8,"NM","B","PSOREJU4",2) "BLD",12484,"KRN",19,0) 19 "BLD",12484,"KRN",19.1,0) 19.1 "BLD",12484,"KRN",101,0) 101 "BLD",12484,"KRN",409.61,0) 409.61 "BLD",12484,"KRN",771,0) 771 "BLD",12484,"KRN",779.2,0) 779.2 "BLD",12484,"KRN",870,0) 870 "BLD",12484,"KRN",8989.51,0) 8989.51 "BLD",12484,"KRN",8989.52,0) 8989.52 "BLD",12484,"KRN",8993,0) 8993 "BLD",12484,"KRN",8994,0) 8994 "BLD",12484,"KRN","B",.4,.4) "BLD",12484,"KRN","B",.401,.401) "BLD",12484,"KRN","B",.402,.402) "BLD",12484,"KRN","B",.403,.403) "BLD",12484,"KRN","B",.5,.5) "BLD",12484,"KRN","B",.84,.84) "BLD",12484,"KRN","B",1.5,1.5) "BLD",12484,"KRN","B",1.6,1.6) "BLD",12484,"KRN","B",1.61,1.61) "BLD",12484,"KRN","B",1.62,1.62) "BLD",12484,"KRN","B",3.6,3.6) "BLD",12484,"KRN","B",3.8,3.8) "BLD",12484,"KRN","B",9.2,9.2) "BLD",12484,"KRN","B",9.8,9.8) "BLD",12484,"KRN","B",19,19) "BLD",12484,"KRN","B",19.1,19.1) "BLD",12484,"KRN","B",101,101) "BLD",12484,"KRN","B",409.61,409.61) "BLD",12484,"KRN","B",771,771) "BLD",12484,"KRN","B",779.2,779.2) "BLD",12484,"KRN","B",870,870) "BLD",12484,"KRN","B",8989.51,8989.51) "BLD",12484,"KRN","B",8989.52,8989.52) "BLD",12484,"KRN","B",8993,8993) "BLD",12484,"KRN","B",8994,8994) "BLD",12484,"QUES",0) ^9.62^^ "BLD",12484,"REQB",0) ^9.611^1^1 "BLD",12484,"REQB",1,0) PSO*7.0*562^2 "BLD",12484,"REQB","B","PSO*7.0*562",1) "FIA",52) PRESCRIPTION "FIA",52,0) ^PSRX( "FIA",52,0,0) 52I "FIA",52,0,1) y^y^p^^^^n^^n "FIA",52,0,10) "FIA",52,0,11) "FIA",52,0,"RLRO") "FIA",52,0,"VR") 7.0^PSO "FIA",52,52) 1 "FIA",52,52.1) 1 "FIA",52,52.1,98) "MBREQ") 1 "PKG",170,-1) 1^1 "PKG",170,0) OUTPATIENT PHARMACY^PSO^OUTPATIENT LABELS, PROFILE, INVENTORY, PRESCRIPTIONS "PKG",170,22,0) ^9.49I^1^1 "PKG",170,22,1,0) 7.0^2971216^2981113^1 "PKG",170,22,1,"PAH",1,0) 648^3220613 "QUES","XPF1",0) Y "QUES","XPF1","??") ^D REP^XPDH "QUES","XPF1","A") Shall I write over your |FLAG| File "QUES","XPF1","B") YES "QUES","XPF1","M") D XPF1^XPDIQ "QUES","XPF2",0) Y "QUES","XPF2","??") ^D DTA^XPDH "QUES","XPF2","A") Want my data |FLAG| yours "QUES","XPF2","B") YES "QUES","XPF2","M") D XPF2^XPDIQ "QUES","XPI1",0) YO "QUES","XPI1","??") ^D INHIBIT^XPDH "QUES","XPI1","A") Want KIDS to INHIBIT LOGONs during the install "QUES","XPI1","B") NO "QUES","XPI1","M") D XPI1^XPDIQ "QUES","XPM1",0) PO^VA(200,:EM "QUES","XPM1","??") ^D MG^XPDH "QUES","XPM1","A") Enter the Coordinator for Mail Group '|FLAG|' "QUES","XPM1","B") "QUES","XPM1","M") D XPM1^XPDIQ "QUES","XPO1",0) Y "QUES","XPO1","??") ^D MENU^XPDH "QUES","XPO1","A") Want KIDS to Rebuild Menu Trees Upon Completion of Install "QUES","XPO1","B") NO "QUES","XPO1","M") D XPO1^XPDIQ "QUES","XPZ1",0) Y "QUES","XPZ1","??") ^D OPT^XPDH "QUES","XPZ1","A") Want to DISABLE Scheduled Options, Menu Options, and Protocols "QUES","XPZ1","B") NO "QUES","XPZ1","M") D XPZ1^XPDIQ "QUES","XPZ2",0) Y "QUES","XPZ2","??") ^D RTN^XPDH "QUES","XPZ2","A") Want to MOVE routines to other CPUs "QUES","XPZ2","B") NO "QUES","XPZ2","M") D XPZ2^XPDIQ "RTN") 3 "RTN","PSOBPSU4") 0^3^B51517974 "RTN","PSOBPSU4",1,0) PSOBPSU4 ;AITC/MRD - BPS (ECME) Utilities 4 ;10/29/2020 "RTN","PSOBPSU4",2,0) ;;7.0;OUTPATIENT PHARMACY;**561,648**;DEC 1997;Build 15 "RTN","PSOBPSU4",3,0) ; "RTN","PSOBPSU4",4,0) BYPASSACT(PSORX) ; 'BY' hidden action, Bypass 3/4 Day Supply. "RTN","PSOBPSU4",5,0) ; "RTN","PSOBPSU4",6,0) ; The 'BY' hidden action allows the user to set a flag, BYPASS "RTN","PSOBPSU4",7,0) ; 3/4 DAY SUPPLY LOGIC, which, when set, causes the 3/4 day "RTN","PSOBPSU4",8,0) ; supply checks to be bypassed during CMOP processing. If the "RTN","PSOBPSU4",9,0) ; flag is already set when the user performs the 'BY' action, "RTN","PSOBPSU4",10,0) ; the flag is reset to 'NO'. "RTN","PSOBPSU4",11,0) ; "RTN","PSOBPSU4",12,0) N DIR,PSOCOMMENT,PSOFILL,PSOFLAG,PSOREASON,Y "RTN","PSOBPSU4",13,0) ; "RTN","PSOBPSU4",14,0) D FULL^VALM1 "RTN","PSOBPSU4",15,0) S VALMBCK="R" "RTN","PSOBPSU4",16,0) ; "RTN","PSOBPSU4",17,0) ; Determine current fill. "RTN","PSOBPSU4",18,0) ; "RTN","PSOBPSU4",19,0) S PSOFILL=$O(^PSRX(PSORX,1,"A"),-1) "RTN","PSOBPSU4",20,0) I PSOFILL="" S PSOFILL=0 "RTN","PSOBPSU4",21,0) ; "RTN","PSOBPSU4",22,0) ; If the Rx/Fill is not e-billable, then display a message and "RTN","PSOBPSU4",23,0) ; Quit out. "RTN","PSOBPSU4",24,0) ; "RTN","PSOBPSU4",25,0) I '$$EBILLABLE^PSOSULB2(PSORX,PSOFILL) D Q "RTN","PSOBPSU4",26,0) . W !!,*7,"***This option only applies to ePharmacy billable prescriptions***",! "RTN","PSOBPSU4",27,0) . S DIR(0)="E",DIR("A")="Press Return to Continue" "RTN","PSOBPSU4",28,0) . D ^DIR "RTN","PSOBPSU4",29,0) . Q "RTN","PSOBPSU4",30,0) ; "RTN","PSOBPSU4",31,0) ; Determine how the flag is currently set. "RTN","PSOBPSU4",32,0) ; "RTN","PSOBPSU4",33,0) S PSOFLAG=$$FLAG(PSORX,PSOFILL) "RTN","PSOBPSU4",34,0) ; "RTN","PSOBPSU4",35,0) ; Display message. "RTN","PSOBPSU4",36,0) ; "RTN","PSOBPSU4",37,0) I PSOFLAG="YES" D "RTN","PSOBPSU4",38,0) . W !!,"Currently, Bypass 3/4 Day Supply is set to YES." "RTN","PSOBPSU4",39,0) . W !!,"If you continue, Bypass 3/4 Day Supply will be set to NO and the 3/4" "RTN","PSOBPSU4",40,0) . W !,"Days Supply logic will apply when the RX is sent to CMOP.",! "RTN","PSOBPSU4",41,0) . Q "RTN","PSOBPSU4",42,0) E D "RTN","PSOBPSU4",43,0) . W !!,"Currently, Bypass 3/4 Day Supply is set to NO." "RTN","PSOBPSU4",44,0) . W !!,"If you continue, Bypass 3/4 Day Supply will be set to YES and the 3/4" "RTN","PSOBPSU4",45,0) . W !,"Days Supply logic will be bypassed when the RX is sent to CMOP.",! "RTN","PSOBPSU4",46,0) . Q "RTN","PSOBPSU4",47,0) ; "RTN","PSOBPSU4",48,0) S DIR(0)="Y",DIR("A")="Continue",DIR("B")="YES" "RTN","PSOBPSU4",49,0) D ^DIR "RTN","PSOBPSU4",50,0) ; "RTN","PSOBPSU4",51,0) I Y'=1 Q "RTN","PSOBPSU4",52,0) ; "RTN","PSOBPSU4",53,0) ; Set or reset the bypass flag for this Rx/fill. "RTN","PSOBPSU4",54,0) ; "RTN","PSOBPSU4",55,0) S PSOFLAG=$S(PSOFLAG="YES":"NO",1:"YES") "RTN","PSOBPSU4",56,0) D SETFLAG(PSORX,PSOFILL,PSOFLAG) "RTN","PSOBPSU4",57,0) ; "RTN","PSOBPSU4",58,0) ; Add a comment to Activity Log. Make the reason S(uspense) if the Rx "RTN","PSOBPSU4",59,0) ; is on the suspense queue; otherwise, make the reason E(dit). "RTN","PSOBPSU4",60,0) ; "RTN","PSOBPSU4",61,0) S PSOCOMMENT="Bypass 3/4 Day Supply set to "_PSOFLAG "RTN","PSOBPSU4",62,0) I $P($$SUSPFILL(PSORX),"^",1)="" S PSOREASON="E" "RTN","PSOBPSU4",63,0) E S PSOREASON="S" "RTN","PSOBPSU4",64,0) D RXACT^PSOBPSU2(PSORX,PSOFILL,PSOCOMMENT,PSOREASON,DUZ) "RTN","PSOBPSU4",65,0) ; "RTN","PSOBPSU4",66,0) Q "RTN","PSOBPSU4",67,0) ; "RTN","PSOBPSU4",68,0) FLAG(PSORX,PSOFILL) ; Determine how the bypass flag is currently set. "RTN","PSOBPSU4",69,0) ; "RTN","PSOBPSU4",70,0) ; This function will return the external value (YES or NO) of the "RTN","PSOBPSU4",71,0) ; Bypass 3/4 Day Supply flag for the given Rx and Fill. "RTN","PSOBPSU4",72,0) ; "RTN","PSOBPSU4",73,0) I PSOFILL=0 Q $$GET1^DIQ(52,PSORX,94,"E") "RTN","PSOBPSU4",74,0) E Q $$GET1^DIQ(52.1,PSOFILL_","_PSORX,98,"E") "RTN","PSOBPSU4",75,0) ; "RTN","PSOBPSU4",76,0) SETFLAG(PSORX,PSOFILL,PSOFLAG) ; Set the bypass flag to the value passed. "RTN","PSOBPSU4",77,0) ; "RTN","PSOBPSU4",78,0) N PSOX "RTN","PSOBPSU4",79,0) ; "RTN","PSOBPSU4",80,0) I PSOFILL=0 D "RTN","PSOBPSU4",81,0) . S PSOX(52,PSORX_",",94)=PSOFLAG "RTN","PSOBPSU4",82,0) . D FILE^DIE("E","PSOX","") "RTN","PSOBPSU4",83,0) . Q "RTN","PSOBPSU4",84,0) E D "RTN","PSOBPSU4",85,0) . S PSOX(52.1,PSOFILL_","_PSORX_",",98)=PSOFLAG "RTN","PSOBPSU4",86,0) . D FILE^DIE("E","PSOX","") "RTN","PSOBPSU4",87,0) . Q "RTN","PSOBPSU4",88,0) ; "RTN","PSOBPSU4",89,0) Q "RTN","PSOBPSU4",90,0) ; "RTN","PSOBPSU4",91,0) BYPASSOPT ; Entry point for menu option Bypass 3/4 Day Supply. "RTN","PSOBPSU4",92,0) ; "RTN","PSOBPSU4",93,0) ; The menu option Bypass 3/4 Day Supply allows the user to select one "RTN","PSOBPSU4",94,0) ; or more prescription for which the Bypass 3/4 Day Supply flag will "RTN","PSOBPSU4",95,0) ; be set. It will also reset the Suspense Date to be today. "RTN","PSOBPSU4",96,0) ; "RTN","PSOBPSU4",97,0) N DEAD,DIC,DIR,INDT,PSOARRAY,PSOCOMMENT,PSOFILL,PSOPROMPT "RTN","PSOBPSU4",98,0) N PSORX,PSORXIEN,PSOSUSPFILL,PSOSUSPIEN,PSOX,SFN,X,Y "RTN","PSOBPSU4",99,0) ; "RTN","PSOBPSU4",100,0) W !!,"Select one or more prescriptions currently on the CMOP suspense" "RTN","PSOBPSU4",101,0) W !,"queue. For each prescription entered, the 3/4 days Supply logic" "RTN","PSOBPSU4",102,0) W !,"will be bypassed when the CMOP process runs. This will apply only" "RTN","PSOBPSU4",103,0) W !,"to the current fill on each ePharmacy billable prescription" "RTN","PSOBPSU4",104,0) W !,"selected.",! "RTN","PSOBPSU4",105,0) ; "RTN","PSOBPSU4",106,0) S PSOPROMPT="Select PRESCRIPTION RX #: " "RTN","PSOBPSU4",107,0) ; "RTN","PSOBPSU4",108,0) B1 ; "RTN","PSOBPSU4",109,0) ; "RTN","PSOBPSU4",110,0) K DIC "RTN","PSOBPSU4",111,0) ; "RTN","PSOBPSU4",112,0) S DIC=52 "RTN","PSOBPSU4",113,0) S DIC(0)="AEMQ" "RTN","PSOBPSU4",114,0) S DIC("A")=PSOPROMPT "RTN","PSOBPSU4",115,0) S DIC("T")="" "RTN","PSOBPSU4",116,0) ; "RTN","PSOBPSU4",117,0) D ^DIC "RTN","PSOBPSU4",118,0) ; "RTN","PSOBPSU4",119,0) ; If the user just hit , skip down to B2. "RTN","PSOBPSU4",120,0) ; "RTN","PSOBPSU4",121,0) I X="" G B2 "RTN","PSOBPSU4",122,0) I Y=-1 G BQ "RTN","PSOBPSU4",123,0) ; "RTN","PSOBPSU4",124,0) S PSORXIEN=+Y "RTN","PSOBPSU4",125,0) S PSORX=$P(Y,"^",2) "RTN","PSOBPSU4",126,0) S PSOPROMPT="Another one: " "RTN","PSOBPSU4",127,0) ; "RTN","PSOBPSU4",128,0) ; Verify that the selected Rx is currently on the CMOP "RTN","PSOBPSU4",129,0) ; suspense queue. "RTN","PSOBPSU4",130,0) ; "RTN","PSOBPSU4",131,0) S PSOSUSPFILL=$$SUSPFILL(PSORXIEN) "RTN","PSOBPSU4",132,0) I $P(PSOSUSPFILL,"^",1)="" D G B1 "RTN","PSOBPSU4",133,0) . W !,*7,?8,"RX is not on CMOP suspense queue" "RTN","PSOBPSU4",134,0) . Q "RTN","PSOBPSU4",135,0) ; "RTN","PSOBPSU4",136,0) ; If the Rx/Fill is not e-billable, then display a message and "RTN","PSOBPSU4",137,0) ; Go back to the prompt (B1). "RTN","PSOBPSU4",138,0) ; "RTN","PSOBPSU4",139,0) I '$$EBILLABLE^PSOSULB2(PSORXIEN,$P(PSOSUSPFILL,"^",1)) D G B1 "RTN","PSOBPSU4",140,0) . W !,*7,?8,"RX is not ePharmacy billable" "RTN","PSOBPSU4",141,0) . Q "RTN","PSOBPSU4",142,0) ; "RTN","PSOBPSU4",143,0) ; If the user enters an Rx already on the list, conditionally "RTN","PSOBPSU4",144,0) ; remove it. "RTN","PSOBPSU4",145,0) ; "RTN","PSOBPSU4",146,0) I $D(PSOARRAY(PSORXIEN)) D G B1 "RTN","PSOBPSU4",147,0) . S DIR(0)="Y" "RTN","PSOBPSU4",148,0) . S DIR("A")="Remove RX "_PSORX_" from your list" "RTN","PSOBPSU4",149,0) . S DIR("B")="YES" "RTN","PSOBPSU4",150,0) . D ^DIR "RTN","PSOBPSU4",151,0) . I Y=1 K PSOARRAY(PSORXIEN) "RTN","PSOBPSU4",152,0) . Q "RTN","PSOBPSU4",153,0) ; "RTN","PSOBPSU4",154,0) ; Add the select Rx to the list. "RTN","PSOBPSU4",155,0) ; "RTN","PSOBPSU4",156,0) S PSOARRAY(PSORXIEN)=PSOSUSPFILL "RTN","PSOBPSU4",157,0) ; "RTN","PSOBPSU4",158,0) G B1 "RTN","PSOBPSU4",159,0) ; "RTN","PSOBPSU4",160,0) B2 ; "RTN","PSOBPSU4",161,0) ; "RTN","PSOBPSU4",162,0) I '$D(PSOARRAY) G BQ "RTN","PSOBPSU4",163,0) ; "RTN","PSOBPSU4",164,0) ; Present to the user the list of all prescriptions selected, "RTN","PSOBPSU4",165,0) ; displaying the Rx#, drug, patient name, and patient ID. "RTN","PSOBPSU4",166,0) ; "RTN","PSOBPSU4",167,0) W !!,"Prescriptions Selected:" "RTN","PSOBPSU4",168,0) ; "RTN","PSOBPSU4",169,0) S PSORXIEN=0 "RTN","PSOBPSU4",170,0) F S PSORXIEN=$O(PSOARRAY(PSORXIEN)) Q:'PSORXIEN D "RTN","PSOBPSU4",171,0) . W !?2,$$GET1^DIQ(52,PSORXIEN,.01,"E") "RTN","PSOBPSU4",172,0) . W ?13,$E($$GET1^DIQ(52,PSORXIEN,6,"E"),1,30) "RTN","PSOBPSU4",173,0) . W ?45,$E($$GET1^DIQ(52,PSORXIEN,2,"E"),1,30) "RTN","PSOBPSU4",174,0) . Q "RTN","PSOBPSU4",175,0) ; "RTN","PSOBPSU4",176,0) W !!,"When the CMOP suspense queue is run, the 3/4 Days Supply logic" "RTN","PSOBPSU4",177,0) W !,"will be bypassed for the current fill for each ePharmacy billable" "RTN","PSOBPSU4",178,0) W !,"prescription selected.",! "RTN","PSOBPSU4",179,0) ; "RTN","PSOBPSU4",180,0) S DIR(0)="Y",DIR("A")="Continue",DIR("B")="YES" "RTN","PSOBPSU4",181,0) D ^DIR "RTN","PSOBPSU4",182,0) I Y'=1 G BQ "RTN","PSOBPSU4",183,0) ; "RTN","PSOBPSU4",184,0) W !!,?5,"Rx",?16,"Drug",?48,"Patient",?63,"New Suspense Date" "RTN","PSOBPSU4",185,0) ; "RTN","PSOBPSU4",186,0) ; For each Rx selected by the user, set the bypass flag to YES, add a "RTN","PSOBPSU4",187,0) ; comment to the activity log, reset the suspense date to be today, "RTN","PSOBPSU4",188,0) ; and call CHANGE^PSOSUCH1 to update two dates in file 52. "RTN","PSOBPSU4",189,0) ; "RTN","PSOBPSU4",190,0) S PSORXIEN=0 "RTN","PSOBPSU4",191,0) F S PSORXIEN=$O(PSOARRAY(PSORXIEN)) Q:'PSORXIEN D "RTN","PSOBPSU4",192,0) . ; "RTN","PSOBPSU4",193,0) . S PSOFILL=$P(PSOARRAY(PSORXIEN),"^",1) "RTN","PSOBPSU4",194,0) . S PSOSUSPIEN=$P(PSOARRAY(PSORXIEN),"^",2) "RTN","PSOBPSU4",195,0) . ; "RTN","PSOBPSU4",196,0) . ; Set the bypass flag for this Rx/fill. "RTN","PSOBPSU4",197,0) . ; "RTN","PSOBPSU4",198,0) . D SETFLAG(PSORXIEN,PSOFILL,"YES") "RTN","PSOBPSU4",199,0) . ; "RTN","PSOBPSU4",200,0) . ; Add comment to Activity Log. "RTN","PSOBPSU4",201,0) . ; "RTN","PSOBPSU4",202,0) . S PSOCOMMENT="Bypass 3/4 Day Supply set to YES" "RTN","PSOBPSU4",203,0) . D RXACT^PSOBPSU2(PSORXIEN,PSOFILL,PSOCOMMENT,"S",DUZ) "RTN","PSOBPSU4",204,0) . ; "RTN","PSOBPSU4",205,0) . ; Reset the suspense date to be today (DT). "RTN","PSOBPSU4",206,0) . ; "RTN","PSOBPSU4",207,0) . S PSOX(52.5,PSOSUSPIEN_",",.02)=DT "RTN","PSOBPSU4",208,0) . D FILE^DIE("E","PSOX","") "RTN","PSOBPSU4",209,0) . ; "RTN","PSOBPSU4",210,0) . ; The call to CHANGE^PSOSUCH1, further down, updates either the Fill "RTN","PSOBPSU4",211,0) . ; Date or Refill Date field in file 52. The input transform for "RTN","PSOBPSU4",212,0) . ; those fields causes the date to be echoed to the screen. To "RTN","PSOBPSU4",213,0) . ; make the display of this date less confusing, we will redisplay "RTN","PSOBPSU4",214,0) . ; each Rx on a line, with the date appearing on the end. "RTN","PSOBPSU4",215,0) . ; "RTN","PSOBPSU4",216,0) . W !?2,$$GET1^DIQ(52,PSORXIEN,.01,"E") "RTN","PSOBPSU4",217,0) . W ?13,$E($$GET1^DIQ(52,PSORXIEN,6,"E"),1,30) "RTN","PSOBPSU4",218,0) . W ?45,$E($$GET1^DIQ(52,PSORXIEN,2,"E"),1,18) "RTN","PSOBPSU4",219,0) . W ?63 "RTN","PSOBPSU4",220,0) . ; "RTN","PSOBPSU4",221,0) . ; CHANGE^PSOSUCH1 updates the Fill (or Refill) Date and the "RTN","PSOBPSU4",222,0) . ; Last Dispensed Date in file 52, Prescription. "RTN","PSOBPSU4",223,0) . ; "RTN","PSOBPSU4",224,0) . S SFN=PSOSUSPIEN "RTN","PSOBPSU4",225,0) . S DEAD=0 "RTN","PSOBPSU4",226,0) . S INDT=DT "RTN","PSOBPSU4",227,0) . D CHANGE^PSOSUCH1(PSORXIEN,PSOFILL) "RTN","PSOBPSU4",228,0) . ; "RTN","PSOBPSU4",229,0) . Q "RTN","PSOBPSU4",230,0) ; "RTN","PSOBPSU4",231,0) BQ ; "RTN","PSOBPSU4",232,0) ; "RTN","PSOBPSU4",233,0) S VALMBCK="R" "RTN","PSOBPSU4",234,0) ; "RTN","PSOBPSU4",235,0) Q "RTN","PSOBPSU4",236,0) ; "RTN","PSOBPSU4",237,0) SUSPFILL(PSORX) ; Determine the fill# currently on the suspense queue. "RTN","PSOBPSU4",238,0) ; "RTN","PSOBPSU4",239,0) ; This function will determine whether a given Rx is on the suspense "RTN","PSOBPSU4",240,0) ; queue. If it is not, or it has already been printed, or it is "RTN","PSOBPSU4",241,0) ; on the queue to be filled locally, this function returns "". "RTN","PSOBPSU4",242,0) ; Otherwise, it returns the fill# (which may be 0/zero). "RTN","PSOBPSU4",243,0) ; It also returns the IEN for the entry in file# 52.5, RX SUSPENSE. "RTN","PSOBPSU4",244,0) ; "RTN","PSOBPSU4",245,0) N PSOFILL,PSOSUSPIEN "RTN","PSOBPSU4",246,0) ; "RTN","PSOBPSU4",247,0) ; Quit with "" if this Rx is not on the suspense queue. "RTN","PSOBPSU4",248,0) ; "RTN","PSOBPSU4",249,0) S PSOSUSPIEN=$O(^PS(52.5,"B",PSORX,"")) "RTN","PSOBPSU4",250,0) I PSOSUSPIEN="" Q "" "RTN","PSOBPSU4",251,0) ; "RTN","PSOBPSU4",252,0) ; Quit with "" if this Rx has already been printed. "RTN","PSOBPSU4",253,0) ; "RTN","PSOBPSU4",254,0) I $$GET1^DIQ(52.5,PSOSUSPIEN,2,"E")="YES" Q "" "RTN","PSOBPSU4",255,0) ; "RTN","PSOBPSU4",256,0) ; Quit with "" if this is a window (local) fill. "RTN","PSOBPSU4",257,0) ; "RTN","PSOBPSU4",258,0) I $$GET1^DIQ(52.5,PSOSUSPIEN,.04,"E")="WINDOW" Q "" "RTN","PSOBPSU4",259,0) ; "RTN","PSOBPSU4",260,0) ; Return the fill# and the IEN to file# 52.5, RX SUSPENSE "RTN","PSOBPSU4",261,0) ; "RTN","PSOBPSU4",262,0) Q $$GET1^DIQ(52.5,PSOSUSPIEN,9)_"^"_PSOSUSPIEN "RTN","PSOBPSU4",263,0) ; "RTN","PSOREJP1") 0^1^B203439370 "RTN","PSOREJP1",1,0) PSOREJP1 ;BIRM/MFR - Third Party Reject Display Screen ;04/29/05 "RTN","PSOREJP1",2,0) ;;7.0;OUTPATIENT PHARMACY;**148,247,260,281,287,289,290,358,359,385,403,421,427,448,478,482,512,562,648**;DEC 1997;Build 15 "RTN","PSOREJP1",3,0) ; Reference to #9002313.93 in ICR #4720 "RTN","PSOREJP1",4,0) ; Reference to ^PS(59.7 in ICR #694 "RTN","PSOREJP1",5,0) ; Reference to ^PSDRUG("AQ" in ICR #3165 "RTN","PSOREJP1",6,0) ; Reference to #9002313.25 in ICR #5064 "RTN","PSOREJP1",7,0) ; Reference to BPSNCPD3 in ICR #4560 "RTN","PSOREJP1",8,0) ; Reference to ^BPSVRX in ICR #5723 "RTN","PSOREJP1",9,0) ; Reference to $$BBILL^BPSBUTL,$$RESUBMIT^BPSBUTL in ICR #4719 "RTN","PSOREJP1",10,0) ; "RTN","PSOREJP1",11,0) EN(RX,REJ,CHANGE) ; Entry point "RTN","PSOREJP1",12,0) ; "RTN","PSOREJP1",13,0) ; - DO NOT change the IF logic below as both of them might get executed (intentional) "RTN","PSOREJP1",14,0) N FILL,LASTLN,PSOTRIC,PSOCODE,PSOTCODE "RTN","PSOREJP1",15,0) S FILL=+$$GET1^DIQ(52.25,REJ_","_RX,5) "RTN","PSOREJP1",16,0) S PSOTRIC=$$TRIC(RX,FILL),PSOCODE=$$GET1^DIQ(52.25,REJ_","_RX,.01) "RTN","PSOREJP1",17,0) S PSOTCODE=0 S:PSOCODE'=79&(PSOCODE'=88)&(PSOCODE'=943)&(PSOTRIC) PSOTCODE=1 "RTN","PSOREJP1",18,0) I $$CLOSED(RX,REJ) D EN^VALM("PSO REJECT DISPLAY - RESOLVED") "RTN","PSOREJP1",19,0) I '$$CLOSED(RX,REJ)&(PSOTRIC) D EN^VALM("PSO REJECT TRICARE") ;cnf, PSO*7*358, replace PSOTCODE with PSOTRIC "RTN","PSOREJP1",20,0) I '$$CLOSED(RX,REJ)&('PSOTCODE)&('PSOTRIC) D EN^VALM("PSO REJECT DISPLAY") ;cnf, PSO*7*358, add PSOTRIC check "RTN","PSOREJP1",21,0) D FULL^VALM1 "RTN","PSOREJP1",22,0) Q "RTN","PSOREJP1",23,0) ; "RTN","PSOREJP1",24,0) HDR ; - Builds the Header section "RTN","PSOREJP1",25,0) N LINE1,LINE2,X "RTN","PSOREJP1",26,0) S VALMHDR(1)=$$DVINFO^PSOREJU2(RX,FILL,1),VALMHDR(2)=$$PTINFO^PSOREJU2(RX,1) "RTN","PSOREJP1",27,0) ;cnf, PSO*7*358, add REJ to parameter list for RXINFO^PSOREJP3 "RTN","PSOREJP1",28,0) S VALMHDR(3)=$$RXINFO^PSOREJP3(RX,FILL,1),VALMHDR(4)=$$RXINFO^PSOREJP3(RX,FILL,2,REJ) "RTN","PSOREJP1",29,0) Q "RTN","PSOREJP1",30,0) ; "RTN","PSOREJP1",31,0) TRIC(RX,RFL,PSOTRIC) ; - Return 1 for TRICARE, 2 for CHAMPVA or 0 (zero) for not TRICARE or CHAMPVA "RTN","PSOREJP1",32,0) I '$D(RFL) S RFL=$$LSTRFL^PSOBPSU1(RX) "RTN","PSOREJP1",33,0) S PSOTRIC="",PSOTRIC=$S(RFL=0&($$GET1^DIQ(52,RX_",",85,"I")="T"):1,$$GET1^DIQ(52.1,RFL_","_RX_",",85,"I")="T":1,RFL=0&($$GET1^DIQ(52,RX_",",85,"I")="C"):2,$$GET1^DIQ(52.1,RFL_","_RX_",",85,"I")="C":2,1:0) "RTN","PSOREJP1",34,0) Q PSOTRIC "RTN","PSOREJP1",35,0) ; "RTN","PSOREJP1",36,0) ELIGDISP(RX,RFL) ; Return either CHAMPVA or TRICARE for display "RTN","PSOREJP1",37,0) ; purposes, or null if neither "RTN","PSOREJP1",38,0) N PSOELIG "RTN","PSOREJP1",39,0) S PSOELIG=$$TRIC(RX,RFL) "RTN","PSOREJP1",40,0) Q $S(PSOELIG=1:"TRICARE",PSOELIG=2:"CHAMPVA",1:"") "RTN","PSOREJP1",41,0) ; "RTN","PSOREJP1",42,0) ELIGTCV(RX,RFL,CAPS) ; Return either CHAMPVA, TRICARE, or Veteran/VETERAN for eligibility display (PSO*7*448) "RTN","PSOREJP1",43,0) ; if CAPS=1 then return "Veteran" in all caps "RTN","PSOREJP1",44,0) ; Note if the requested refill has been deleted, then the message "N/A - Fill Deleted" will be returned "RTN","PSOREJP1",45,0) N PSOELIG,VET,DELMSG "RTN","PSOREJP1",46,0) S DELMSG="N/A - Fill Deleted" "RTN","PSOREJP1",47,0) S PSOELIG=$$TRIC(RX,RFL),VET="Veteran" I $G(CAPS) S VET="VETERAN" "RTN","PSOREJP1",48,0) I RFL>0,'$D(^PSRX(RX,1,RFL,0)) S PSOELIG=3 "RTN","PSOREJP1",49,0) Q $S(PSOELIG=1:"TRICARE",PSOELIG=2:"CHAMPVA",PSOELIG=3:DELMSG,1:VET) "RTN","PSOREJP1",50,0) ; "RTN","PSOREJP1",51,0) INIT ; Builds the Body section "RTN","PSOREJP1",52,0) N DATA,LINE "RTN","PSOREJP1",53,0) I '$D(FILL) S FILL=+$$GET1^DIQ(52.25,REJ_","_RX,5) ; PSO*7*448 obtain fill# from 52.25 subfile if not defined "RTN","PSOREJP1",54,0) I '$$CLOSED(RX,REJ) S VALM("TITLE")="Reject Information ("_$$ELIGTCV(RX,FILL)_")" "RTN","PSOREJP1",55,0) I $$CLOSED(RX,REJ) S VALM("TITLE")="Reject Information (RESOLVED)" "RTN","PSOREJP1",56,0) F I=1:1:$G(LASTLN) D RESTORE^VALM10(I) "RTN","PSOREJP1",57,0) K ^TMP("PSOREJP1",$J) S VALMCNT=0,LINE=0 "RTN","PSOREJP1",58,0) D GET^PSOREJU2(RX,FILL,.DATA,REJ,1) "RTN","PSOREJP1",59,0) D REJ ; Display the REJECT Information "RTN","PSOREJP1",60,0) D OTH ; Display the Other Rejects Information "RTN","PSOREJP1",61,0) D COM^PSOREJP3 ; Display the Comment "RTN","PSOREJP1",62,0) D INS ; Display the Insurance Information "RTN","PSOREJP1",63,0) D CLS ; Display the Resolution Information "RTN","PSOREJP1",64,0) S VALMCNT=LINE "RTN","PSOREJP1",65,0) Q "RTN","PSOREJP1",66,0) ; "RTN","PSOREJP1",67,0) REJ ; - Reject Information "RTN","PSOREJP1",68,0) N TYPE,PFLDT,TREJ,TDATA,PSOET,PSONAF,PSOCOB,PSOTXT,PSOECME,PSOADD S TDATA="" "RTN","PSOREJP1",69,0) ; "RTN","PSOREJP1",70,0) ; LH;PSO*7*448 - Display 'RESUBMISSION' where 'BACK-BILL' currently "RTN","PSOREJP1",71,0) ; displays if the claim was resubmitted from the ECME User Screen. "RTN","PSOREJP1",72,0) ; To facilitate this, the function $$RESUBMIT^BPSBUTL was created. "RTN","PSOREJP1",73,0) ; "RTN","PSOREJP1",74,0) ; Back Bill indicator - PSO*7*421 "RTN","PSOREJP1",75,0) S PSOTXT="",PSOCOB=$G(DATA(REJ,"COB")),PSOCOB=$S(PSOCOB="SECONDARY":2,PSOCOB="TERTIARY":3,1:1) "RTN","PSOREJP1",76,0) I $$BBILL^BPSBUTL(RX,FILL,PSOCOB) S PSOTXT=" BACK-BILL" "RTN","PSOREJP1",77,0) E I $$RESUBMIT^BPSBUTL(RX,FILL,PSOCOB) S PSOTXT=" RESUBMISSION" ; IA 4719. "RTN","PSOREJP1",78,0) D SETLN("REJECT Information ("_$$ELIGTCV(RX,FILL)_") "_PSOTXT,1,1) "RTN","PSOREJP1",79,0) S PSOECME=$$STATUS^PSOBPSUT(RX,FILL,PSOCOB) "RTN","PSOREJP1",80,0) I PSOECME="E PAYABLE" D "RTN","PSOREJP1",81,0) . D SETLN("Reject Type : ",,,18) "RTN","PSOREJP1",82,0) . D SETLN("Reject Status : ** E PAYABLE **",,,18) "RTN","PSOREJP1",83,0) . Q "RTN","PSOREJP1",84,0) E D "RTN","PSOREJP1",85,0) . S TYPE=$S($G(DATA(REJ,"CODE"))=79:"79 - REFILL TOO SOON",1:"") "RTN","PSOREJP1",86,0) . I TYPE="" S TYPE=DATA(REJ,"CODE")_" - "_$E($$EXP(DATA(REJ,"CODE")),1,23)_"-" "RTN","PSOREJP1",87,0) . D SETLN("Reject Type : "_TYPE_" received on "_$$FMTE^XLFDT($G(DATA(REJ,"DATE/TIME"))),,,18) "RTN","PSOREJP1",88,0) . ;cnf, PSO*7*358, if TRICARE/CHAMPVA non-billable then reset Status line "RTN","PSOREJP1",89,0) . S PSOET=$$PSOET^PSOREJP3(RX,FILL) "RTN","PSOREJP1",90,0) . I PSOET D SETLN("Status : NO CLAIM SUBMITTED") "RTN","PSOREJP1",91,0) . I 'PSOET D SETLN("Reject Status : "_$G(DATA(REJ,"STATUS"))_" - "_PSOECME,,,18) "RTN","PSOREJP1",92,0) . Q "RTN","PSOREJP1",93,0) ; code moved to PSOREJP5 "RTN","PSOREJP1",94,0) D REJ^PSOREJP5 "RTN","PSOREJP1",95,0) Q "RTN","PSOREJP1",96,0) ; "RTN","PSOREJP1",97,0) OTH ; - Other Rejects Information "RTN","PSOREJP1",98,0) N LST,I,RJC,J,LAST "RTN","PSOREJP1",99,0) S LST=$G(DATA(REJ,"OTHER REJECTS")) I LST="" Q "RTN","PSOREJP1",100,0) D SETLN() "RTN","PSOREJP1",101,0) D SETLN("OTHER REJECTS",1,1) "RTN","PSOREJP1",102,0) F I=1:1:$L(LST,",") S RJC=$P(LST,",",I) D "RTN","PSOREJP1",103,0) . S LAST=1 F J=(I+1):1:$L(LST,",") I $P(LST,",",J)'="" S LAST=0 Q "RTN","PSOREJP1",104,0) . I RJC'="" D SETLN(RJC_" - "_$$EXP(RJC),,$S(LAST:1,1:0),6) "RTN","PSOREJP1",105,0) Q "RTN","PSOREJP1",106,0) ; "RTN","PSOREJP1",107,0) INS ; - Insurance Information "RTN","PSOREJP1",108,0) D SETLN() "RTN","PSOREJP1",109,0) D SETLN("INSURANCE Information",1,1) "RTN","PSOREJP1",110,0) N PSOINS,PSOINS1,I,PSOBINPCN "RTN","PSOREJP1",111,0) S PSOINS=$G(DATA(REJ,"INSURANCE NAME")) "RTN","PSOREJP1",112,0) F I=1:1:(50-($L(PSOINS)+18)) S PSOINS=PSOINS_" " "RTN","PSOREJP1",113,0) S PSOINS1=$G(DATA(REJ,"COB")) "RTN","PSOREJP1",114,0) I PSOINS1="SECONDARY" S PSOINS=PSOINS_"Coord. Of Benefits: "_PSOINS1 "RTN","PSOREJP1",115,0) D SETLN("Insurance : "_PSOINS,,,18) "RTN","PSOREJP1",116,0) D SETLN("Contact : "_$G(DATA(REJ,"PLAN CONTACT")),,,18) "RTN","PSOREJP1",117,0) S PSOBINPCN=$G(DATA(REJ,"BIN"))_"/ "_$G(DATA(REJ,"PCN")) "RTN","PSOREJP1",118,0) D SETLN("BIN/ PCN : "_PSOBINPCN,,,18) "RTN","PSOREJP1",119,0) D SETLN("Group Number : "_$E($G(DATA(REJ,"GROUP NUMBER")),1,15),,,18) "RTN","PSOREJP1",120,0) D SETLN("Cardholder ID : "_$E($G(DATA(REJ,"CARDHOLDER ID")),1,20),,1,18) "RTN","PSOREJP1",121,0) Q "RTN","PSOREJP1",122,0) ; "RTN","PSOREJP1",123,0) CLS ; - Resolution Information "RTN","PSOREJP1",124,0) N X "RTN","PSOREJP1",125,0) I '$$CLOSED(RX,REJ) Q "RTN","PSOREJP1",126,0) D SETLN() "RTN","PSOREJP1",127,0) D SETLN("RESOLUTION Information",1,1) "RTN","PSOREJP1",128,0) D SETLN("Resolved By : "_$G(DATA(REJ,"CLOSED BY")),,,18) "RTN","PSOREJP1",129,0) D SETLN("Date/Time : "_$G(DATA(REJ,"CLOSED DATE/TIME")),,,18) "RTN","PSOREJP1",130,0) I $G(DATA(REJ,"CLOSE COMMENTS"))'="" D SET("CLOSE COMMENTS",63) "RTN","PSOREJP1",131,0) I $G(DATA(REJ,"COD1"))'="" D SETLN("Reason for Svc : "_$$OVRX^PSOREJU1(1,$G(DATA(REJ,"COD1"))),,,18) "RTN","PSOREJP1",132,0) I $G(DATA(REJ,"COD2"))'="" D SETLN("Profes. Svc : "_$$OVRX^PSOREJU1(2,$G(DATA(REJ,"COD2"))),,,18) "RTN","PSOREJP1",133,0) I $G(DATA(REJ,"COD3"))'="" D SETLN("Result of Svc : "_$$OVRX^PSOREJU1(3,$G(DATA(REJ,"COD3"))),,,18) "RTN","PSOREJP1",134,0) I $G(DATA(REJ,"CLA CODE"))'="" D "RTN","PSOREJP1",135,0) . N CLAPNTR S CLAPNTR=$O(^BPS(9002313.25,"B",DATA(REJ,"CLA CODE"),"")) "RTN","PSOREJP1",136,0) . S X=DATA(REJ,"CLA CODE")_" - "_$$GET1^DIQ(9002313.25,CLAPNTR,".02") "RTN","PSOREJP1",137,0) . D SETLN("Clarific. Code : "_X,,,18) "RTN","PSOREJP1",138,0) I $G(DATA(REJ,"PRIOR AUTH TYPE"))'="" D "RTN","PSOREJP1",139,0) . S X=$$GET1^DIQ(52.25,REJ_","_RX,25,"I")_" - "_(DATA(REJ,"PRIOR AUTH TYPE")) "RTN","PSOREJP1",140,0) . D SETLN("Prior Auth.Type: "_X,,,18),SETLN("Prior Auth. # : "_DATA(REJ,"PRIOR AUTH NUMBER"),,,18) "RTN","PSOREJP1",141,0) D SETLN("Reason : "_$G(DATA(REJ,"CLOSE REASON")),,1,18) "RTN","PSOREJP1",142,0) Q "RTN","PSOREJP1",143,0) ; "RTN","PSOREJP1",144,0) ; "RTN","PSOREJP1",145,0) SET(FIELD,L,UND) ; Sets the lines for fields that require text wrapping "RTN","PSOREJP1",146,0) N TXT,T "RTN","PSOREJP1",147,0) S TXT=DATA(REJ,FIELD) I $L(TXT)'>L D SETLN($$LABEL(FIELD)_TXT,,$S($G(UND):1,1:0),80-L) Q "RTN","PSOREJP1",148,0) F I=1:1 Q:TXT="" D "RTN","PSOREJP1",149,0) . I I=1 D SETLN($$LABEL(FIELD)_$E(TXT,1,L),,,80-L) S TXT=$E(TXT,L+1,999) Q "RTN","PSOREJP1",150,0) . S T="",$E(T,81-L)=$E(TXT,1,L) D SETLN(T,,$S($E(TXT,L+1,999)=""&$G(UND):1,1:0),80-L) S TXT=$E(TXT,L+1,999) "RTN","PSOREJP1",151,0) Q "RTN","PSOREJP1",152,0) ; "RTN","PSOREJP1",153,0) LABEL(FIELD) ; Sets the label for the field "RTN","PSOREJP1",154,0) I FIELD="REASON" Q "Reason Code : " "RTN","PSOREJP1",155,0) I FIELD="PAYER MESSAGE" Q "Payer Addl Msg : " "RTN","PSOREJP1",156,0) I FIELD="DUR TEXT" Q $S(+$$ISDUR^PSOREJP5(RX,REJ):"+DUR Text : ",1:"DUR Text : ") "RTN","PSOREJP1",157,0) I FIELD="CLOSE COMMENTS" Q "Comments : " "RTN","PSOREJP1",158,0) Q "" "RTN","PSOREJP1",159,0) ; "RTN","PSOREJP1",160,0) VIEW ; - Rx View hidden action "RTN","PSOREJP1",161,0) N VALMCNT,TITLE "RTN","PSOREJP1",162,0) I $G(PSOBACK) D Q "RTN","PSOREJP1",163,0) . S VALMSG="Not available through Backdoor!",VALMBCK="R" "RTN","PSOREJP1",164,0) S TITLE=VALM("TITLE") "RTN","PSOREJP1",165,0) ; "RTN","PSOREJP1",166,0) ; - DO structure used to avoid losing variables RX,FILL,REJ,LINE,TITLE "RTN","PSOREJP1",167,0) DO "RTN","PSOREJP1",168,0) . N PSOVDA,DA,PS "RTN","PSOREJP1",169,0) . S (PSOVDA,DA)=RX,PS="REJECT" "RTN","PSOREJP1",170,0) . N RX,REJ,FILL,LINE,TITLE D DP^PSORXVW "RTN","PSOREJP1",171,0) ; "RTN","PSOREJP1",172,0) S VALMBCK="R",VALM("TITLE")=TITLE "RTN","PSOREJP1",173,0) Q "RTN","PSOREJP1",174,0) ; "RTN","PSOREJP1",175,0) EDT ; - Rx Edit hidden action "RTN","PSOREJP1",176,0) N VALMCNT,TITLE "RTN","PSOREJP1",177,0) I $G(PSOBACK) D Q "RTN","PSOREJP1",178,0) . S VALMSG="Not available through Backdoor!",VALMBCK="R" "RTN","PSOREJP1",179,0) S TITLE=VALM("TITLE") "RTN","PSOREJP1",180,0) ; "RTN","PSOREJP1",181,0) ; - DO structure used to avoid losing variables RX,FILL,REJ,LINE,TITLE "RTN","PSOREJP1",182,0) DO "RTN","PSOREJP1",183,0) . N PSOSITE,ORN,PSOPAR,PSOLIST,PSOREJCT "RTN","PSOREJP1",184,0) . S PSOSITE=$$RXSITE^PSOBPSUT(RX,FILL),ORN=RX "RTN","PSOREJP1",185,0) . S PSOPAR=$G(^PS(59,PSOSITE,1)),PSOLIST(1)=ORN_"," "RTN","PSOREJP1",186,0) . ; Variable PSOREJCT is used so that EPH^PSORXEDT has the RX 'passed' by this routine "RTN","PSOREJP1",187,0) . S PSOREJCT=RX_U_FILL "RTN","PSOREJP1",188,0) . N RX,REJ,FILL,LINE,TITLE D EPH^PSORXEDT "RTN","PSOREJP1",189,0) ; "RTN","PSOREJP1",190,0) K VALMBCK I $$CLOSED(RX,REJ),$D(PSOSTFLT),PSOSTFLT="U" S CHANGE=1 Q "RTN","PSOREJP1",191,0) S VALMBCK="R",VALM("TITLE")=TITLE "RTN","PSOREJP1",192,0) Q "RTN","PSOREJP1",193,0) ; "RTN","PSOREJP1",194,0) OVR ; - Override a REJECT action "RTN","PSOREJP1",195,0) N PSOET "RTN","PSOREJP1",196,0) I $$CLOSED(RX,REJ,1) Q "RTN","PSOREJP1",197,0) ;cnf, PSO*7*358 "RTN","PSOREJP1",198,0) S PSOET=$$PSOET^PSOREJP3(RX,FILL) "RTN","PSOREJP1",199,0) I PSOET S VALMSG="OVR not allowed for "_$$ELIGDISP(RX,FILL)_" Non-Billable claim.",VALMBCK="R" Q "RTN","PSOREJP1",200,0) N COD1,COD2,COD3 "RTN","PSOREJP1",201,0) D FULL^VALM1 W ! "RTN","PSOREJP1",202,0) S COD1=$$OVRCOD^PSOREJU1(1,$$GET1^DIQ(52.25,REJ_","_RX,14)) I COD1="^"!(COD1="") S VALMBCK="R" Q "RTN","PSOREJP1",203,0) S COD2=$$OVRCOD^PSOREJU1(2) I COD2="^" S VALMBCK="R" Q "RTN","PSOREJP1",204,0) S COD3=$$OVRCOD^PSOREJU1(3) I COD3="^" S VALMBCK="R" Q "RTN","PSOREJP1",205,0) D OVRDSP^PSOREJU1(COD1_"^"_COD2_"^"_COD3) "RTN","PSOREJP1",206,0) D SEND^PSOREJP3(COD1_"^"_COD2_"^"_COD3,,,PSOET) "RTN","PSOREJP1",207,0) Q "RTN","PSOREJP1",208,0) ; "RTN","PSOREJP1",209,0) RES ; - Re-submit a claim action "RTN","PSOREJP1",210,0) N PSOET "RTN","PSOREJP1",211,0) I $$CLOSED(RX,REJ,1) Q "RTN","PSOREJP1",212,0) ;cnf, PSO*7*358 "RTN","PSOREJP1",213,0) S PSOET=$$PSOET^PSOREJP3(RX,FILL) "RTN","PSOREJP1",214,0) D FULL^VALM1 W ! "RTN","PSOREJP1",215,0) D SEND^PSOREJP3(,,,PSOET) "RTN","PSOREJP1",216,0) Q "RTN","PSOREJP1",217,0) ; "RTN","PSOREJP1",218,0) CLA ; - Submit Clarification Code "RTN","PSOREJP1",219,0) N CLA,PSOET "RTN","PSOREJP1",220,0) I $$CLOSED(RX,REJ,1) Q "RTN","PSOREJP1",221,0) ;cnf, PSO*7*358 "RTN","PSOREJP1",222,0) S PSOET=$$PSOET^PSOREJP3(RX,FILL) "RTN","PSOREJP1",223,0) I PSOET S VALMSG="CLA not allowed for "_$$ELIGDISP(RX,FILL)_" Non-Billable claim.",VALMBCK="R" Q "RTN","PSOREJP1",224,0) D FULL^VALM1 W ! "RTN","PSOREJP1",225,0) ; Prompt for the Submission Clarification Codes (up to three) "RTN","PSOREJP1",226,0) S CLA=$$CLA^PSOREJU1() I CLA="^"!(CLA="") S VALMBCK="R" Q "RTN","PSOREJP1",227,0) W ! D SEND^PSOREJP3(,CLA,,PSOET) "RTN","PSOREJP1",228,0) Q "RTN","PSOREJP1",229,0) ; "RTN","PSOREJP1",230,0) PA ; - Submit Prior Authorization "RTN","PSOREJP1",231,0) N PA,PSOET "RTN","PSOREJP1",232,0) I $$CLOSED(RX,REJ,1) Q "RTN","PSOREJP1",233,0) ;cnf, PSO*7*358 "RTN","PSOREJP1",234,0) S PSOET=$$PSOET^PSOREJP3(RX,FILL) "RTN","PSOREJP1",235,0) I PSOET S VALMSG="PA not allowed for "_$$ELIGDISP(RX,FILL)_" Non-Billable claim.",VALMBCK="R" Q "RTN","PSOREJP1",236,0) D FULL^VALM1 W ! "RTN","PSOREJP1",237,0) ; Prompt for Prior Auth fields "RTN","PSOREJP1",238,0) S PA=$$PA^PSOREJU2() I PA="^" S VALMBCK="R" Q "RTN","PSOREJP1",239,0) W ! D SEND^PSOREJP3(,,PA,PSOET) "RTN","PSOREJP1",240,0) Q "RTN","PSOREJP1",241,0) ; "RTN","PSOREJP1",242,0) MP ; - Patient Medication Profile "RTN","PSOREJP1",243,0) I $G(PSOBACK) D Q "RTN","PSOREJP1",244,0) . S VALMSG="Not available through Backdoor!",VALMBCK="R" "RTN","PSOREJP1",245,0) N SITE,PATIENT "RTN","PSOREJP1",246,0) D FULL^VALM1 W ! "RTN","PSOREJP1",247,0) S SITE=+$$RXSITE^PSOBPSUT(RX,FILL) S:$G(PSOSITE) SITE=PSOSITE "RTN","PSOREJP1",248,0) S PATIENT=+$$GET1^DIQ(52,RX,2,"I") "RTN","PSOREJP1",249,0) D LST^PSOPMP0(SITE,PATIENT) S VALMBCK="R" "RTN","PSOREJP1",250,0) Q "RTN","PSOREJP1",251,0) ; "RTN","PSOREJP1",252,0) EXIT ; "RTN","PSOREJP1",253,0) K ^TMP("PSOREJP1",$J) "RTN","PSOREJP1",254,0) Q "RTN","PSOREJP1",255,0) ; "RTN","PSOREJP1",256,0) SETLN(TEXT,REV,UND,HIG) ; Sets a line to be displayed in the Body section "RTN","PSOREJP1",257,0) N X "RTN","PSOREJP1",258,0) S:$G(TEXT)="" $E(TEXT,80)="" "RTN","PSOREJP1",259,0) S:$L(TEXT)>80 TEXT=$E(TEXT,1,80) "RTN","PSOREJP1",260,0) S LINE=LINE+1,^TMP("PSOREJP1",$J,LINE,0)=$G(TEXT) "RTN","PSOREJP1",261,0) ; "RTN","PSOREJP1",262,0) I LINE>$G(LASTLN) D SAVE^VALM10(LINE) S LASTLN=LINE "RTN","PSOREJP1",263,0) ; "RTN","PSOREJP1",264,0) I $G(REV) D Q "RTN","PSOREJP1",265,0) . D CNTRL^VALM10(LINE,1,$L(TEXT),IORVON,IOINORM) "RTN","PSOREJP1",266,0) . I $G(UND) D CNTRL^VALM10(LINE,$L(TEXT)+1,80,IOUON,IOINORM) "RTN","PSOREJP1",267,0) I $G(UND) D CNTRL^VALM10(LINE,1,80,IOUON,IOINORM) "RTN","PSOREJP1",268,0) I $G(HIG) D "RTN","PSOREJP1",269,0) . D CNTRL^VALM10(LINE,HIG,80,IOINHI_$S($G(UND):IOUON,1:""),IOINORM) "RTN","PSOREJP1",270,0) Q "RTN","PSOREJP1",271,0) HELP ; "RTN","PSOREJP1",272,0) Q "RTN","PSOREJP1",273,0) ; "RTN","PSOREJP1",274,0) CLOSED(RX,REJ,MSG) ; Returns whether the REJECT is RESOLVED or NOT "RTN","PSOREJP1",275,0) I $$GET1^DIQ(52.25,REJ_","_RX,10,"I") D:$G(MSG) Q 1 "RTN","PSOREJP1",276,0) . S VALMSG="This Reject is marked resolved!",VALMBCK="R" W $C(7) "RTN","PSOREJP1",277,0) Q 0 "RTN","PSOREJP1",278,0) ; "RTN","PSOREJP1",279,0) REOPN(RX,REJ) ; Returns whether the REJECT was RE-OPENED or NOT "RTN","PSOREJP1",280,0) Q $S($$GET1^DIQ(52.25,REJ_","_RX,23)="":0,1:1) "RTN","PSOREJP1",281,0) ; "RTN","PSOREJP1",282,0) EXP(CODE) ; - Returns the explanation field (.02) for a reject code "RTN","PSOREJP1",283,0) ; Input: (r) CODE - .01 field (Code) value from file 9002313.93 "RTN","PSOREJP1",284,0) ; Output: .02 field (Explanation) value from file 9002313.93 "RTN","PSOREJP1",285,0) N DIC,X,Y "RTN","PSOREJP1",286,0) S DIC=9002313.93,DIC(0)="Z",X=CODE D ^DIC "RTN","PSOREJP1",287,0) Q $P($G(Y(0)),"^",2) "RTN","PSOREJP1",288,0) ; "RTN","PSOREJP1",289,0) OUT(RX) ; - Supported call by outside PROTOCOLs to act on specific REJECTs "RTN","PSOREJP1",290,0) N I,RFL,DATA,REJ,PSOBACK,VALMCNT,RXN "RTN","PSOREJP1",291,0) I '$D(^XUSEC("PSORPH",DUZ)) D Q "RTN","PSOREJP1",292,0) . S VALMSG="PSORPH key required to use the REJ action.",VALMBCK="R" "RTN","PSOREJP1",293,0) I $G(PS)="REJECT" D "RTN","PSOREJP1",294,0) . S VALMSG="REJ action is not available at this point.",VALMBCK="R" "RTN","PSOREJP1",295,0) S PSOBACK=1 "RTN","PSOREJP1",296,0) S (RFL,I)=0 F I=1:1 Q:'$D(^PSRX(RX,1,I)) S RFL=I "RTN","PSOREJP1",297,0) S X=$$FIND^PSOREJUT(RX,RFL,.DATA,,1) S REJ=$O(DATA("")) "RTN","PSOREJP1",298,0) I '$G(REJ) S VALMSG="Invalid selection!",VALMBCK="R" Q "RTN","PSOREJP1",299,0) D EN(RX,REJ) S VALMBCK="R" "RTN","PSOREJP1",300,0) Q "RTN","PSOREJP1",301,0) ; "RTN","PSOREJP1",302,0) SMA ;Submit multiple actions "RTN","PSOREJP1",303,0) N CLA,I,OVR,OVRSTR,PA,REJIEN,DUR,RSC,DURIEN,REQ,RSUB,PSOET "RTN","PSOREJP1",304,0) I $$CLOSED(RX,REJ,1) Q "RTN","PSOREJP1",305,0) S PSOET=$$PSOET^PSOREJP3(RX,FILL) "RTN","PSOREJP1",306,0) I PSOET S VALMSG="SMA not allowed for "_$$ELIGDISP(RX,FILL)_" Non-Billable claim.",VALMBCK="R" Q "RTN","PSOREJP1",307,0) D FULL^VALM1 W ! "RTN","PSOREJP1",308,0) S DURIEN=$P($G(^PSRX(RX,"REJ",REJ,0)),U,11) "RTN","PSOREJP1",309,0) D DURRESP^BPSNCPD3(DURIEN,.DUR) ; Reference to BPSNCPD3 supported by IA 4560 "RTN","PSOREJP1",310,0) ; "RTN","PSOREJP1",311,0) ; Prompt for Prior Auth fields "RTN","PSOREJP1",312,0) S PA=$$PA^PSOREJU2 "RTN","PSOREJP1",313,0) I PA="^" S VALMBCK="R" Q ;User terminated or did not answer "RTN","PSOREJP1",314,0) ; "RTN","PSOREJP1",315,0) ; Prompt for submission clarification codes (up to three) "RTN","PSOREJP1",316,0) W ! "RTN","PSOREJP1",317,0) S CLA=$$CLA^PSOREJU1 "RTN","PSOREJP1",318,0) I CLA="^" S VALMBCK="R" Q ;User terminated or did not answer "RTN","PSOREJP1",319,0) ; "RTN","PSOREJP1",320,0) ; Check if DUR Overrides required - PSO*7*421 "RTN","PSOREJP1",321,0) S REQ=$$REQ I REQ="^" S VALMBCK="R" Q "RTN","PSOREJP1",322,0) ; "RTN","PSOREJP1",323,0) ; Prompt for DUR Overrides (up to 3) - option to delete default added - PSO*7*421 "RTN","PSOREJP1",324,0) S OVRSTR="",OVR="" "RTN","PSOREJP1",325,0) I REQ S REJIEN=0 F RSUB=1:1:3 D Q:OVR="^"!(OVR="")!(OVR="@") S $P(OVRSTR,"~",RSUB)=OVR "RTN","PSOREJP1",326,0) . I REJIEN]"" S REJIEN=$O(DUR(1,"DUR PPS",REJIEN)) "RTN","PSOREJP1",327,0) . S RSC="" I +REJIEN S RSC=$P($G(DUR(1,"DUR PPS",REJIEN,"REASON FOR SERVICE CODE"))," ",1) "RTN","PSOREJP1",328,0) . S OVR=$$SMAOVR^PSOREJU1(RSC,RSUB) "RTN","PSOREJP1",329,0) I OVR="^" S VALMBCK="R" Q ;User exited or timed-out "RTN","PSOREJP1",330,0) ; "RTN","PSOREJP1",331,0) W !!,?6,"RECAP:" "RTN","PSOREJP1",332,0) W !,?6,"Prior Authorization Type : ",$P(PA,"^")," ",$$DSC^PSOREJU1(9002313.26,$P(PA,"^"),.02) "RTN","PSOREJP1",333,0) W !,?6,"Prior Authorization Number : ",$P(PA,"^",2) "RTN","PSOREJP1",334,0) W !,?6,"Submission Clarification Code 1: ",$P(CLA,"~",1)," ",$$DSC^PSOREJU1(9002313.25,$P(CLA,"~",1),.02) "RTN","PSOREJP1",335,0) I $P(CLA,"~",2)]"" W !,?6,"Submission Clarification Code 2: ",$P(CLA,"~",2)," ",$$DSC^PSOREJU1(9002313.25,$P(CLA,"~",2),.02) "RTN","PSOREJP1",336,0) I $P(CLA,"~",3)]"" W !,?6,"Submission Clarification Code 3: ",$P(CLA,"~",3)," ",$$DSC^PSOREJU1(9002313.25,$P(CLA,"~",3),.02) "RTN","PSOREJP1",337,0) W !,?6,"Reason for Service Code 1 : ",$P($P(OVRSTR,"~",1),U,1)," ",$$DSC^PSOREJU1(9002313.23,$P($P(OVRSTR,"~",1),U,1),1) "RTN","PSOREJP1",338,0) W !,?6,"Professional Service Code 1 : ",$P($P(OVRSTR,"~",1),U,2)," ",$$DSC^PSOREJU1(9002313.21,$P($P(OVRSTR,"~",1),U,2),1) "RTN","PSOREJP1",339,0) W !,?6,"Result of Service Code 1 : ",$P($P(OVRSTR,"~",1),U,3)," ",$$DSC^PSOREJU1(9002313.22,$P($P(OVRSTR,"~",1),U,3),1) "RTN","PSOREJP1",340,0) I $P($P(OVRSTR,"~",2),U,1)]"" W !,?6,"Reason for Service Code 2 : ",$P($P(OVRSTR,"~",2),U,1)," ",$$DSC^PSOREJU1(9002313.23,$P($P(OVRSTR,"~",2),U,1),1) "RTN","PSOREJP1",341,0) I $P($P(OVRSTR,"~",2),U,2)]"" W !,?6,"Professional Service Code 2 : ",$P($P(OVRSTR,"~",2),U,2)," ",$$DSC^PSOREJU1(9002313.21,$P($P(OVRSTR,"~",2),U,2),1) "RTN","PSOREJP1",342,0) I $P($P(OVRSTR,"~",2),U,3)]"" W !,?6,"Result of Service Code 2 : ",$P($P(OVRSTR,"~",2),U,3)," ",$$DSC^PSOREJU1(9002313.22,$P($P(OVRSTR,"~",2),U,3),1) "RTN","PSOREJP1",343,0) I $P($P(OVRSTR,"~",3),U,1)]"" W !,?6,"Reason for Service Code 3 : ",$P($P(OVRSTR,"~",3),U,1)," ",$$DSC^PSOREJU1(9002313.23,$P($P(OVRSTR,"~",3),U,1),1) "RTN","PSOREJP1",344,0) I $P($P(OVRSTR,"~",3),U,2)]"" W !,?6,"Professional Service Code 3 : ",$P($P(OVRSTR,"~",3),U,2)," ",$$DSC^PSOREJU1(9002313.21,$P($P(OVRSTR,"~",3),U,2),1) "RTN","PSOREJP1",345,0) I $P($P(OVRSTR,"~",3),U,3)]"" W !,?6,"Result of Service Code 3 : ",$P($P(OVRSTR,"~",3),U,3)," ",$$DSC^PSOREJU1(9002313.22,$P($P(OVRSTR,"~",3),U,3),1) "RTN","PSOREJP1",346,0) W ! D SEND^PSOREJP3(OVRSTR,CLA,PA,PSOET) "RTN","PSOREJP1",347,0) Q "RTN","PSOREJP1",348,0) ; "RTN","PSOREJP1",349,0) VRX ; View ePharmacy Prescription - invoked from the Reject Information screen "RTN","PSOREJP1",350,0) N BPSVRX "RTN","PSOREJP1",351,0) K ^TMP("BPSVRX1-PSO VIEW RX",$J,"PSOHDR") "RTN","PSOREJP1",352,0) D FULL^VALM1 "RTN","PSOREJP1",353,0) ; "RTN","PSOREJP1",354,0) ; save the current header display "RTN","PSOREJP1",355,0) M ^TMP("BPSVRX1-PSO VIEW RX",$J,"PSOHDR")=^TMP("PSOHDR",$J) "RTN","PSOREJP1",356,0) ; "RTN","PSOREJP1",357,0) S BPSVRX("RXIEN")=$G(RX) "RTN","PSOREJP1",358,0) S BPSVRX("FILL#")=$G(FILL) "RTN","PSOREJP1",359,0) D ^BPSVRX ; DBIA #5723 "RTN","PSOREJP1",360,0) ; "RTN","PSOREJP1",361,0) ; restore the header display "RTN","PSOREJP1",362,0) I '$D(^TMP("PSOHDR",$J)) M ^TMP("PSOHDR",$J)=^TMP("BPSVRX1-PSO VIEW RX",$J,"PSOHDR") "RTN","PSOREJP1",363,0) ; "RTN","PSOREJP1",364,0) S VALMBCK="R" "RTN","PSOREJP1",365,0) K ^TMP("BPSVRX1-PSO VIEW RX",$J,"PSOHDR") "RTN","PSOREJP1",366,0) Q "RTN","PSOREJP1",367,0) ; "RTN","PSOREJP1",368,0) VER ; View ePharmacy Prescription - invoked from the Rx view hidden action of Medication Profile "RTN","PSOREJP1",369,0) N BPSVRX "RTN","PSOREJP1",370,0) K ^TMP("BPSVRX-PSO VIEW RX",$J) "RTN","PSOREJP1",371,0) D FULL^VALM1 "RTN","PSOREJP1",372,0) ; "RTN","PSOREJP1",373,0) ; save the current PSO Rx display array and header "RTN","PSOREJP1",374,0) M ^TMP("BPSVRX-PSO VIEW RX",$J,"PSOHDR")=^TMP("PSOHDR",$J) "RTN","PSOREJP1",375,0) M ^TMP("BPSVRX-PSO VIEW RX",$J,"PSOAL")=^TMP("PSOAL",$J) "RTN","PSOREJP1",376,0) ; "RTN","PSOREJP1",377,0) S BPSVRX("RXIEN")=$G(RXN) ; Rx ien ptr file 52 "RTN","PSOREJP1",378,0) D ^BPSVRX ; DBIA #5723 "RTN","PSOREJP1",379,0) ; "RTN","PSOREJP1",380,0) ; restore the PSO Rx display array and header upon return "RTN","PSOREJP1",381,0) I '$D(^TMP("PSOHDR",$J)) M ^TMP("PSOHDR",$J)=^TMP("BPSVRX-PSO VIEW RX",$J,"PSOHDR") "RTN","PSOREJP1",382,0) I '$D(^TMP("PSOAL",$J)) M ^TMP("PSOAL",$J)=^TMP("BPSVRX-PSO VIEW RX",$J,"PSOAL") "RTN","PSOREJP1",383,0) ; "RTN","PSOREJP1",384,0) S VALMBCK="R" "RTN","PSOREJP1",385,0) K ^TMP("BPSVRX-PSO VIEW RX",$J) "RTN","PSOREJP1",386,0) Q "RTN","PSOREJP1",387,0) ; "RTN","PSOREJP1",388,0) REQ() ;Prompt if DUR Rejects are required "RTN","PSOREJP1",389,0) N DIR,DTOUT,DTOUT,DIRUT,DIROUT,X,Y "RTN","PSOREJP1",390,0) S DIR("?")="Enter No if Reason Codes are not required. Enter Yes to proceed and enter up to 3 sets of override Reason Codes. To delete default Reason Codes, enter ""@""." "RTN","PSOREJP1",391,0) S DIR("A")="Enter DUR codes",DIR(0)="Y",DIR("B")="YES" W ! D ^DIR "RTN","PSOREJP1",392,0) I $D(DIRUT)!$D(DIROUT) Q "^" ;User exited or timed-out "RTN","PSOREJP1",393,0) Q Y "RTN","PSOREJU4") 0^2^B96109069 "RTN","PSOREJU4",1,0) PSOREJU4 ;BIRM/LE - Pharmacy Reject Overrides ;06/26/08 "RTN","PSOREJU4",2,0) ;;7.0;OUTPATIENT PHARMACY;**289,290,358,359,385,421,448,561,562,648**;DEC 1997;Build 15 "RTN","PSOREJU4",3,0) ; Reference to DUR1^BPSNCPD3 in ICR #4560 "RTN","PSOREJU4",4,0) ; Reference to 9002313.93 in ICR #4720 "RTN","PSOREJU4",5,0) ; Reference to ELIG^BPSBUTL in ICR #4719 "RTN","PSOREJU4",6,0) ; "RTN","PSOREJU4",7,0) AUTOREJ(CODES,PSODIV) ;API to evaluate an array of reject codes to see if they are allowed to be passed to OP reject Worklist "RTN","PSOREJU4",8,0) ;Input: CODES - required; array of codes to be validated for overrides. "RTN","PSOREJU4",9,0) ; PSODIV - optional; Division for the Rx and Fill to be evaluated "RTN","PSOREJU4",10,0) ; "RTN","PSOREJU4",11,0) ;Output: CODES(0)=0 always - ALLOW ALL REJECTS flag was inactivated with patch 421 "RTN","PSOREJU4",12,0) ; "RTN","PSOREJU4",13,0) ; CODES(SEQ,REJECT)= 0 (zero) if the fill is not allowed to be passed to the Pharmacy "RTN","PSOREJU4",14,0) ; Reject Worklist or 1 (one) for the reject code is allowed. "RTN","PSOREJU4",15,0) ; "RTN","PSOREJU4",16,0) N SEQ,COD,AUTO,ALLOW,SPDIV "RTN","PSOREJU4",17,0) ;if no division passed, first division in file 59 is assumed. "RTN","PSOREJU4",18,0) I '$G(PSODIV) S PSODIV=0,PSODIV=$O(^PS(59,PSODIV)) "RTN","PSOREJU4",19,0) I '$G(PSODIV) S CODES(0)="0^Division undefined in file 59" Q "RTN","PSOREJU4",20,0) S SPDIV="",SPDIV=$O(^PS(52.86,"B",PSODIV,SPDIV)) "RTN","PSOREJU4",21,0) I SPDIV="" S CODES(0)="0^Division is not defined under ePharmacy Site Parameters option." Q "RTN","PSOREJU4",22,0) ; "RTN","PSOREJU4",23,0) ; - all rejects allowed flag obsolete, set to 0 for parameter integrity "RTN","PSOREJU4",24,0) S CODES(0)=0 "RTN","PSOREJU4",25,0) ; "RTN","PSOREJU4",26,0) ; - check individual reject codes. If defined, can be passed to Pharmacy Reject Worklist "RTN","PSOREJU4",27,0) S (COD,SEQ)="" F S SEQ=$O(CODES(SEQ)) Q:SEQ="" F S COD=$O(CODES(SEQ,COD)) Q:COD="" D "RTN","PSOREJU4",28,0) . I $D(^PS(52.86,+SPDIV,1,"B",COD)) S CODES(SEQ,COD)=1 "RTN","PSOREJU4",29,0) . E S CODES(SEQ,COD)=0 "RTN","PSOREJU4",30,0) Q "RTN","PSOREJU4",31,0) ; "RTN","PSOREJU4",32,0) WRKLST(RX,RFL,COMMTXT,USERID,DTTIME,OPECC,RXCOB,RESP) ;External API to store reject codes other that 79/88/943/TRICARE/CHAMPVA on the OP Reject Worklist "RTN","PSOREJU4",33,0) ; "RTN","PSOREJU4",34,0) N REJ,REJS,REJLST,I,IDX,CODE,DATA,TXT,PSOTRIC,SPDVI,PSODIV,REJCD,CLOSECHK,REJIDX "RTN","PSOREJU4",35,0) S PSODIV=$$RXSITE^PSOBPSUT(RX,RFL) "RTN","PSOREJU4",36,0) L +^PSRX("REJ",RX):15 Q:'$T "0^Rx locked by another user." "RTN","PSOREJU4",37,0) I $G(RFL)="" S RFL=$$LSTRFL^PSOBPSU1(RX) "RTN","PSOREJU4",38,0) D DUR1^BPSNCPD3(RX,RFL,.REJ,"",RXCOB) "RTN","PSOREJU4",39,0) ;cnf, PSO*7*358, add TRICARE logic "RTN","PSOREJU4",40,0) S REJCD="",CLOSECHK=0 "RTN","PSOREJU4",41,0) I $L($G(RESP)) D "RTN","PSOREJU4",42,0) .I $P(RESP,"^",3)'="T",$P(RESP,"^",3)'="C" Q ;ignore if not TRICARE or CHAMPVA "RTN","PSOREJU4",43,0) .I 'RESP Q ;Piece 1 will be 0 if claim was submitted thru ECME "RTN","PSOREJU4",44,0) .S REJCD="e"_$P(RESP,"^",3) ; either eT for TRICARE or eC for CHAMPVA "RTN","PSOREJU4",45,0) .S REJ(1,"REJ CODE LST")=REJCD "RTN","PSOREJU4",46,0) .S REJ(1,"PAYER MESSAGE",1)="Not ECME Billable: "_$P(RESP,U,2) "RTN","PSOREJU4",47,0) .S REJ(1,"ELIGBLT")=$P(RESP,"^",3) "RTN","PSOREJU4",48,0) .S CLOSECHK=1 "RTN","PSOREJU4",49,0) S PSOTRIC="",PSOTRIC=$$TRIC^PSOREJP1(RX,RFL,PSOTRIC) "RTN","PSOREJU4",50,0) K REJS S (AUTO,IDX)="" "RTN","PSOREJU4",51,0) F S IDX=$O(REJ(IDX)) Q:IDX="" D Q:AUTO'="" "RTN","PSOREJU4",52,0) . S TXT=REJ(IDX,"REJ CODE LST") "RTN","PSOREJU4",53,0) . F I=1:1:$L(TXT,",") D "RTN","PSOREJU4",54,0) . . S CODE=$P(TXT,",",I) "RTN","PSOREJU4",55,0) . . I CODE="" Q ;BNT-2/15/11 Rare, but could happen that a code is null. "RTN","PSOREJU4",56,0) . . ; "RTN","PSOREJU4",57,0) . . ; An Rx can only have 1 open/unresolved eC/eT code. "RTN","PSOREJU4",58,0) . . ; Orders for patients with no active insurance will now "RTN","PSOREJU4",59,0) . . ; result in a "NOT INSURED" eC/eT reject code, which "RTN","PSOREJU4",60,0) . . ; is higher priority than any existing eC/eT reject codes. "RTN","PSOREJU4",61,0) . . ; The logic below determines if the eC/eT reject code to "RTN","PSOREJU4",62,0) . . ; be added is for "NOT INSURED". If so, it will loop "RTN","PSOREJU4",63,0) . . ; through the REJECT INFO subfile, for the Rx, and close "RTN","PSOREJU4",64,0) . . ; an open/unresolved eC/eT reject, if any, allowing the "RTN","PSOREJU4",65,0) . . ; "NOT INSURED" eC/eT reject code to be added to the order. "RTN","PSOREJU4",66,0) . . I $P($G(RESP),"^",2)="NOT INSURED"&((CODE="eC")!(CODE="eT")) D "RTN","PSOREJU4",67,0) . . . S REJIDX=0 "RTN","PSOREJU4",68,0) . . . F S REJIDX=$O(^PSRX(RX,"REJ","B",CODE,REJIDX)) Q:'REJIDX D "RTN","PSOREJU4",69,0) . . . . I +$$GET1^DIQ(52.25,REJIDX_","_RX,9,"I")=1 Q ; already closed "RTN","PSOREJU4",70,0) . . . . I $$GET1^DIQ(52.25,REJIDX_","_RX,2)["NOT INSURED" Q ; already has an unresolved not insured reject "RTN","PSOREJU4",71,0) . . . . D CLOSE^PSOREJUT(RX,RFL,REJIDX,"",1) "RTN","PSOREJU4",72,0) . . ; "RTN","PSOREJU4",73,0) . . I CODE'="79"&(CODE'="88")&(CODE'="943")&('$G(PSOTRIC)) S AUTO=$$EVAL(PSODIV,CODE,OPECC) Q:'+AUTO "RTN","PSOREJU4",74,0) . . I PSOTRIC S AUTO=1 ;cnf, send all billable and non-billable rejects to worklist if TRICARE or CHAMPVA "RTN","PSOREJU4",75,0) . . I $$DUP^PSOREJU1(RX,+$$CLEAN^PSOREJU1($G(REJ(IDX,"RESPONSE IEN"))),CLOSECHK) S AUTO="0^Rx is already on Pharmacy Reject Worklist." "RTN","PSOREJU4",76,0) . . S REJS(IDX,CODE)="" "RTN","PSOREJU4",77,0) I '$D(REJS) L -^PSRX("REJ",RX) S AUTO="0^No action taken" Q AUTO "RTN","PSOREJU4",78,0) G EXIT:'+AUTO "RTN","PSOREJU4",79,0) ; "RTN","PSOREJU4",80,0) D SYNC2^PSOREJUT "RTN","PSOREJU4",81,0) S AUTO=1 "RTN","PSOREJU4",82,0) EXIT ; "RTN","PSOREJU4",83,0) L -^PSRX("REJ",RX) "RTN","PSOREJU4",84,0) Q AUTO "RTN","PSOREJU4",85,0) ; "RTN","PSOREJU4",86,0) EVAL(PSODIV,CODE,OPECC,RX,RFNBR,COB,RRRDATA) ;Evaluates whether the reject codes other than 79/88/TRICARE/CHAMPVA is allowed to be passed to OP Reject Worklist "RTN","PSOREJU4",87,0) ;Input: PSODIV - required; Division for the Rx and Fill to be evaluated "RTN","PSOREJU4",88,0) ; CODE - required; external reject code "RTN","PSOREJU4",89,0) ; OPECC - optional, 1 means manually passed by OPECC 0 or null means not passed "RTN","PSOREJU4",90,0) ; RX - optional; IEN from prescription file "RTN","PSOREJU4",91,0) ; RFNBR - optional; refill number "RTN","PSOREJU4",92,0) ; COB - optional; coordination of benefits "RTN","PSOREJU4",93,0) ;Output: $$EVAL - Return value - 1 means reject is allowed to be passed to Pharmacy Reject Worklist and "RTN","PSOREJU4",94,0) ; 0 means not allowed. "RTN","PSOREJU4",95,0) ; When doing a RRR check, RX, RFNBR & COB are required. "RTN","PSOREJU4",96,0) ; RRRDATA - passed by reference. "RTN","PSOREJU4",97,0) ; RRRDATA [1] 1/0 is this an RRR reject? "RTN","PSOREJU4",98,0) ; [2] gross amount due for the Rx/fill/cob "RTN","PSOREJU4",99,0) ; [3] $ dollar threshold amount from PSO site parameters "RTN","PSOREJU4",100,0) ; "RTN","PSOREJU4",101,0) N ALLOWA,CIEN,ALLOW,ICOD,SPDIV "RTN","PSOREJU4",102,0) I '$D(CODE)!(CODE="") Q 0 "RTN","PSOREJU4",103,0) I '$G(OPECC) S OPECC=0 "RTN","PSOREJU4",104,0) I '$G(PSODIV) Q 0 "RTN","PSOREJU4",105,0) S SPDIV="",SPDIV=$O(^PS(52.86,"B",PSODIV,SPDIV)) "RTN","PSOREJU4",106,0) Q:SPDIV="" "0^Division is not defined under ePharmacy Site Parameters option." "RTN","PSOREJU4",107,0) S:'$G(AUTO) AUTO="" "RTN","PSOREJU4",108,0) S ICOD="",ICOD=$O(^BPSF(9002313.93,"B",CODE,ICOD)) "RTN","PSOREJU4",109,0) Q:ICOD="" 0 "RTN","PSOREJU4",110,0) ; "RTN","PSOREJU4",111,0) ; Check for Resolution Required Reject code if so, return a 1 "RTN","PSOREJU4",112,0) I $G(RX),$D(RFNBR),$D(COB) S RRRDATA=$$RRRCHK(SPDIV,ICOD,RX,RFNBR,COB) I +RRRDATA Q 1 "RTN","PSOREJU4",113,0) ; "RTN","PSOREJU4",114,0) ; Transfer reject processing "RTN","PSOREJU4",115,0) Q:'$D(^PS(52.86,SPDIV,1,"B",ICOD)) "0^Reject Code is not allowed to be passed to Pharmacy Reject Worklist." "RTN","PSOREJU4",116,0) S CIEN="",CIEN=$O(^PS(52.86,SPDIV,1,"B",ICOD,CIEN)) "RTN","PSOREJU4",117,0) I CIEN="" S AUTO="0^Code not defined." "RTN","PSOREJU4",118,0) S (AUTO,ALLOW)="",ALLOW=$$GET1^DIQ(52.8651,CIEN_","_SPDIV,1,"I") "RTN","PSOREJU4",119,0) I ALLOW Q 1 "RTN","PSOREJU4",120,0) I 'ALLOW D "RTN","PSOREJU4",121,0) . I OPECC S AUTO=1 "RTN","PSOREJU4",122,0) . I 'OPECC S AUTO="0^Reject code "_CODE_" cannot be placed on the Pharmacy Reject Worklist" "RTN","PSOREJU4",123,0) Q AUTO "RTN","PSOREJU4",124,0) ; "RTN","PSOREJU4",125,0) INLIST(RX,RFL,RXCOB) ;Returns whether a prescription/fill contains UNRESOLVED rejects "RTN","PSOREJU4",126,0) ;Input: "RTN","PSOREJU4",127,0) ;RX - Prescription IEN. "RTN","PSOREJU4",128,0) ;FILL - Fill number being processed. "RTN","PSOREJU4",129,0) ;Output: "RTN","PSOREJU4",130,0) ;0 - the fill is not on the Pharmacy Reject Worklist "RTN","PSOREJU4",131,0) ;1 - the fill is already on the Pharmacy Reject Worklist "RTN","PSOREJU4",132,0) N PSOX,PSOX1,PSOX2,REJDATA1 "RTN","PSOREJU4",133,0) S PSOX=$$FIND^PSOREJUT(RX,RFL,.REJDATA1,"") I PSOX=0 Q 0 "RTN","PSOREJU4",134,0) S RXCOB=$S(RXCOB=1:"PRIMARY",RXCOB=2:"SECONDARY") "RTN","PSOREJU4",135,0) S PSOX1="" F S PSOX1=$O(REJDATA1(PSOX1)) Q:PSOX1="" I REJDATA1(PSOX1,"COB")=RXCOB S PSOX2=1 Q "RTN","PSOREJU4",136,0) I '$G(PSOX2) Q 0 "RTN","PSOREJU4",137,0) Q 1 "RTN","PSOREJU4",138,0) ; "RTN","PSOREJU4",139,0) MULTI(RX,RFL,REJDATA,CODE,REJS,RRRFLG) ;due to routine size, called from FIND^PSOREJUT "RTN","PSOREJU4",140,0) ;returns REJS = 1 means reject code found on Rx, 0 (zero) means not found "RTN","PSOREJU4",141,0) N RCODE,I "RTN","PSOREJU4",142,0) I $G(RFL)'="" D "RTN","PSOREJU4",143,0) . F I=1:1 S RCODE=$P(CODE,",",I) Q:RCODE=""!($G(REJS)) D GET^PSOREJU2(RX,RFL,.REJDATA,,,$G(RCODE),+$G(RRRFLG)) I $D(REJDATA) S REJS=1 "RTN","PSOREJU4",144,0) E S RFL=0 D I '$D(REJDATA) F S RFL=$O(^PSRX(RX,1,RFL)) Q:'RFL D Q:$G(REJS) "RTN","PSOREJU4",145,0) . F I=1:1 S RCODE=$P(CODE,",",I) Q:RCODE=""!($G(REJS)) D GET^PSOREJU2(RX,RFL,.REJDATA,,,$G(RCODE),+$G(RRRFLG)) I $D(REJDATA) S REJS=1 "RTN","PSOREJU4",146,0) Q REJS "RTN","PSOREJU4",147,0) ; "RTN","PSOREJU4",148,0) SINGLE(RX,RFL,REJDATA,CODE,REJS,RRRFLG) ;due to routine size, called from FIND^PSOREJUT "RTN","PSOREJU4",149,0) ;Returns REJS = 1 means reject code found on Rx, 0 (zero) means not found "RTN","PSOREJU4",150,0) I $G(RFL)'="" D "RTN","PSOREJU4",151,0) . D GET^PSOREJU2(RX,RFL,.REJDATA,,,$G(CODE),+$G(RRRFLG)) "RTN","PSOREJU4",152,0) E S RFL=0 D I '$D(REJDATA) F S RFL=$O(^PSRX(RX,1,RFL)) Q:'RFL D "RTN","PSOREJU4",153,0) . D GET^PSOREJU2(RX,RFL,.REJDATA,,,$G(CODE),+$G(RRRFLG)) "RTN","PSOREJU4",154,0) S REJS=$S($D(REJDATA):1,1:0) "RTN","PSOREJU4",155,0) Q REJS "RTN","PSOREJU4",156,0) ; "RTN","PSOREJU4",157,0) RRRCHK(SPDIV,REJ,RX,RFNBR,COB) ; Test a reject for valid Resolution Required Reject code "RTN","PSOREJU4",158,0) ; INPUT "RTN","PSOREJU4",159,0) ; SPDIV = required - IEN in site parameter file for the selected division "RTN","PSOREJU4",160,0) ; REJ = required - IEN of the Reject code to test "RTN","PSOREJU4",161,0) ; RX = required - IEN from prescription file "RTN","PSOREJU4",162,0) ; RFNBR = required - prescription refill number "RTN","PSOREJU4",163,0) ; COB = optional - coordination of benefits "RTN","PSOREJU4",164,0) ; "RTN","PSOREJU4",165,0) ; OUTPUT "RTN","PSOREJU4",166,0) ; Function Value - Returns an "^" delimited string "RTN","PSOREJU4",167,0) ; [1] 1/0 is this an RRR reject? "RTN","PSOREJU4",168,0) ; 1 = Valid resolution required reject code. "RTN","PSOREJU4",169,0) ; 0 = Invalid resolution required reject code. "RTN","PSOREJU4",170,0) ; [2] If valid RRR then gross amount due for the Rx/fill/cob else null "RTN","PSOREJU4",171,0) ; [3] If valid RRR then dollar threshold amount from PSO site parameters else null "RTN","PSOREJU4",172,0) ; "RTN","PSOREJU4",173,0) ; For a reject code to be valid each of the following needs to be true: "RTN","PSOREJU4",174,0) ; 1 - Eligibility must be a veteran type "RTN","PSOREJU4",175,0) ; 2 - Must be the first fill on a prescription "RTN","PSOREJU4",176,0) ; 3 - Reject code must be defined in the pharmacy division's site parameters "RTN","PSOREJU4",177,0) ; as a resolution required reject code. "RTN","PSOREJU4",178,0) ; 4 - Gross amount must be >= DOLLAR THRESHOLD in the pharmacy division's site "RTN","PSOREJU4",179,0) ; parameters for the given resolution required reject code. "RTN","PSOREJU4",180,0) ; "RTN","PSOREJU4",181,0) ; Verify parameters "RTN","PSOREJU4",182,0) I '$G(SPDIV) Q 0 "RTN","PSOREJU4",183,0) I '$D(^PS(52.86,SPDIV)) Q 0 "RTN","PSOREJU4",184,0) I '$G(REJ) Q 0 "RTN","PSOREJU4",185,0) I '$D(^BPSF(9002313.93,REJ,0)) Q 0 ; DBIA 4720 "RTN","PSOREJU4",186,0) I '$G(RX) Q 0 "RTN","PSOREJU4",187,0) I '$D(^PSRX(RX)) Q 0 "RTN","PSOREJU4",188,0) I '$D(RFNBR) Q 0 "RTN","PSOREJU4",189,0) ; "RTN","PSOREJU4",190,0) N RRRC,AMT,THRSHLD "RTN","PSOREJU4",191,0) ; SPDIV = IEN in site parameter file for the selected division "RTN","PSOREJU4",192,0) ; RRRC = indicates the RESOLUTION REQUIRED REJECT CODE exists for the selected division "RTN","PSOREJU4",193,0) ; it will be a null or an IEN in the 52.865 sub-file "RTN","PSOREJU4",194,0) ; AMT = RX gross amount due "RTN","PSOREJU4",195,0) ; THRSHLD = DOLLAR THRESHOLD for RRR code "RTN","PSOREJU4",196,0) ; "RTN","PSOREJU4",197,0) ; Test for released status "RTN","PSOREJU4",198,0) I $$GET1^DIQ(52,RX_",",31,"I") Q 0 "RTN","PSOREJU4",199,0) ; "RTN","PSOREJU4",200,0) ; Test Eligibility - IA 4719 "RTN","PSOREJU4",201,0) I $$ELIG^BPSBUTL(RX,0,$G(COB))'="V" Q 0 "RTN","PSOREJU4",202,0) ; "RTN","PSOREJU4",203,0) ; is this a Resolution Required Reject code? "RTN","PSOREJU4",204,0) S RRRC=0,RRRC=$O(^PS(52.86,SPDIV,5,"B",REJ,RRRC)) "RTN","PSOREJU4",205,0) I RRRC="" Q 0 "RTN","PSOREJU4",206,0) ; "RTN","PSOREJU4",207,0) ; Test gross amount against DOLLAR THRESHOLD "RTN","PSOREJU4",208,0) S AMT=$$AMT^BPSBUTL(RX,0,$G(COB)) "RTN","PSOREJU4",209,0) S THRSHLD=$$GET1^DIQ(52.865,RRRC_","_SPDIV_",",.02) "RTN","PSOREJU4",210,0) I AMT0) D "RTN","PSXRPPL2",50,0) . . S SDT=PRTDT "RTN","PSXRPPL2",51,0) . . F S SDT=$O(^PS(52.5,"CMP","Q",PSXTYP,PSXTDIV,SDT)) Q:(SDT>PSXDTRG)!(SDT="") D "RTN","PSXRPPL2",52,0) . . . S REC=0 "RTN","PSXRPPL2",53,0) . . . F S REC=$O(^PS(52.5,"CMP","Q",PSXTYP,PSXTDIV,SDT,XDFN,REC)) Q:REC'>0 D "RTN","PSXRPPL2",54,0) . . . . S (PSOLRX,RX)=+$$GET1^DIQ(52.5,REC,.01,"I") I 'RX Q "RTN","PSXRPPL2",55,0) . . . . S RFL=$$GET1^DIQ(52.5,REC,9,"I") I RFL="" S RFL=$$LSTRFL^PSOBPSU1(RX) "RTN","PSXRPPL2",56,0) . . . . I $$XMIT^PSXBPSUT(REC) D "RTN","PSXRPPL2",57,0) . . . . . I SDT>THRDT,'$D(^TMP("PSXEPHDFN",$J,XDFN)) Q "RTN","PSXRPPL2",58,0) . . . . . I $$PATCH^XPDUTL("PSO*7.0*148") D "RTN","PSXRPPL2",59,0) . . . . . . I $$RETRX^PSOBPSUT(RX,RFL),SDT>DT Q "RTN","PSXRPPL2",60,0) . . . . . . I $$DOUBLE^PSXRPPL1(RX,RFL) Q "RTN","PSXRPPL2",61,0) . . . . . . I $$FIND^PSOREJUT(RX,RFL,,"79,88,943",,1) Q "RTN","PSXRPPL2",62,0) . . . . . . ; "RTN","PSXRPPL2",63,0) . . . . . . ; If TRI/CVA and the Rx already has a closed eT/eC "RTN","PSXRPPL2",64,0) . . . . . . ; pseudo-reject, then do not send another claim. "RTN","PSXRPPL2",65,0) . . . . . . ; "RTN","PSXRPPL2",66,0) . . . . . . I $$TRICVANB^PSXRPPL1(RX,RFL) D Q "RTN","PSXRPPL2",67,0) . . . . . . . D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-CHKDFN, $$TRICVANB returned 1") ; ICR #4412,6764 "RTN","PSXRPPL2",68,0) . . . . . . ; "RTN","PSXRPPL2",69,0) . . . . . . I '$$RETRX^PSOBPSUT(RX,RFL),$$ECMESTAT(RX,RFL) Q "RTN","PSXRPPL2",70,0) . . . . . . I $$PATCH^XPDUTL("PSO*7.0*289"),'$$DUR(RX,RFL),'$$DSH(REC,1) Q "RTN","PSXRPPL2",71,0) . . . . . . ; "RTN","PSXRPPL2",72,0) . . . . . . ; ECMESND^PSOBPSU1 initiates the claim submission process. "RTN","PSXRPPL2",73,0) . . . . . . ; "RTN","PSXRPPL2",74,0) . . . . . . D ECMESND^PSOBPSU1(RX,RFL,"","PC",,1,,,,.RESP) "RTN","PSXRPPL2",75,0) . . . . . . ; "RTN","PSXRPPL2",76,0) . . . . . . D LOG^BPSOSL($$IEN59^BPSOSRX(RX,RFL),$T(+0)_"-CHKDFN, RESP="_$G(RESP)) ; ICR #4412,6764 "RTN","PSXRPPL2",77,0) . . . . . . ; "RTN","PSXRPPL2",78,0) . . . . . . I $G(RESP)'["IN PROGRESS",$$PATCH^XPDUTL("PSO*7.0*287"),$$TRISTA^PSOREJU3(RX,RFL,.RESP,"PC") S ^TMP("PSXEPHNB",$J,RX,RFL)=$G(RESP) "RTN","PSXRPPL2",79,0) . . . . . . ; "RTN","PSXRPPL2",80,0) . . . . . . I $D(RESP),'RESP S SBTECME=SBTECME+1 "RTN","PSXRPPL2",81,0) . . . . . . S ^TMP("PSXEPHDFN",$J,XDFN)="" "RTN","PSXRPPL2",82,0) . . . . D PSOUL^PSSLOCK(PSOLRX) "RTN","PSXRPPL2",83,0) K ^TMP("PSXEPHDFN",$J) "RTN","PSXRPPL2",84,0) I SBTECME>0 H 60+$S((SBTECME*15)>7200:7200,1:(SBTECME*15)) "RTN","PSXRPPL2",85,0) Q "RTN","PSXRPPL2",86,0) ; "RTN","PSXRPPL2",87,0) ; EPHARM is called only by GETDATA^PSXRPPL. The variable EPHQT is "RTN","PSXRPPL2",88,0) ; Newed in GETDATA. If EPHQT is set to 1 here, then GETDATA does "RTN","PSXRPPL2",89,0) ; not continue processing the current Rx/Fill; this Rx/Fill will "RTN","PSXRPPL2",90,0) ; not be sent to CMOP if EPHQT is set to 1 here. "RTN","PSXRPPL2",91,0) ; "RTN","PSXRPPL2",92,0) EPHARM ; - ePharmacy checks for third party billing "RTN","PSXRPPL2",93,0) ; "RTN","PSXRPPL2",94,0) ; If CMOP is still processing the previous fill ($$DOUBLE), or if the "RTN","PSXRPPL2",95,0) ; RE-TRANSMIT flag is 'Yes' and the send date is in the future, or if "RTN","PSXRPPL2",96,0) ; this prescription has an unresolved 79,88,943, or RRR reject, then "RTN","PSXRPPL2",97,0) ; Set EPHQT to 1 and Quit. This Rx/Fill will not be sent to CMOP. "RTN","PSXRPPL2",98,0) ; "RTN","PSXRPPL2",99,0) I $$DOUBLE^PSXRPPL1(RXN,RFL) S EPHQT=1 Q "RTN","PSXRPPL2",100,0) I $$RETRX^PSOBPSUT(RXN,RFL),SDT>DT S EPHQT=1 Q "RTN","PSXRPPL2",101,0) I $$FIND^PSOREJUT(RXN,RFL,,"79,88,943",,1) S EPHQT=1 Q "RTN","PSXRPPL2",102,0) ; "RTN","PSXRPPL2",103,0) ; If an Open/Unresolved eC/eT reject on claim, don't send to CMOP. "RTN","PSXRPPL2",104,0) I $$ECETREJ(RXN) D EPH Q "RTN","PSXRPPL2",105,0) ; "RTN","PSXRPPL2",106,0) ; $$TRISTA performs checks specific to TRICARE/CHAMPVA. If the claim "RTN","PSXRPPL2",107,0) ; was rejected or is still "IN PROGRESS", or if it is non-billable, "RTN","PSXRPPL2",108,0) ; then add this Rx to the ^TMP("PSXEPHIN") array and quit. "RTN","PSXRPPL2",109,0) ; "RTN","PSXRPPL2",110,0) I $$PATCH^XPDUTL("PSO*7.0*287"),$$TRISTA^PSOREJU3(RXN,RFL,.RESP,"PC") D EPH Q "RTN","PSXRPPL2",111,0) I $$PATCH^XPDUTL("PSO*7.0*287"),$D(^TMP("PSXEPHNB",$J,RXN,RFL)) D EPH Q "RTN","PSXRPPL2",112,0) ; "RTN","PSXRPPL2",113,0) ; If the claim is still "IN PROGRESS", then add this Rx to the "RTN","PSXRPPL2",114,0) ; ^TMP("PSXEPHIN") array and quit. "RTN","PSXRPPL2",115,0) ; "RTN","PSXRPPL2",116,0) I $$STATUS^PSOBPSUT(RXN,RFL)="IN PROGRESS" D EPH Q "RTN","PSXRPPL2",117,0) ; "RTN","PSXRPPL2",118,0) ; If this Prescription violates the 3/4 supply (i.e. if it is too soon "RTN","PSXRPPL2",119,0) ; to refill), then Set EPHQT to 1 and Quit. This Rx/Fill will not be "RTN","PSXRPPL2",120,0) ; sent to CMOP. "RTN","PSXRPPL2",121,0) ; "RTN","PSXRPPL2",122,0) I $$PATCH^XPDUTL("PSO*7.0*289"),'$$DSH(REC,0) D S EPHQT=1 Q "RTN","PSXRPPL2",123,0) . D LOG^BPSOSL($$IEN59^BPSOSRX(RXN,RFL),$T(+0)_"-EPHARM, Failed DSH") ; ICR #4412,6764 "RTN","PSXRPPL2",124,0) ; "RTN","PSXRPPL2",125,0) ; If there is a host reject for this Rx/Fill, then add this Rx to the "RTN","PSXRPPL2",126,0) ; ^TMP("PSXEPHIN") array and quit. "RTN","PSXRPPL2",127,0) ; "RTN","PSXRPPL2",128,0) I $$PATCH^XPDUTL("PSO*7.0*289"),'$$DUR(RXN,RFL) D EPH Q "RTN","PSXRPPL2",129,0) Q "RTN","PSXRPPL2",130,0) ; "RTN","PSXRPPL2",131,0) ; EPH is called only by EPHARM, above. It adds a prescriptions to the "RTN","PSXRPPL2",132,0) ; ^TMP("PSXEPHIN") array. Of those Prescriptions not sent to the CMOP "RTN","PSXRPPL2",133,0) ; facility and left in the suspense queue, some are added to this "RTN","PSXRPPL2",134,0) ; array. Those in this array will be listed in the email sent to users "RTN","PSXRPPL2",135,0) ; indicating that they were left in the queue (see ^PSXBPSMS). That "RTN","PSXRPPL2",136,0) ; email states these Rxs were not transmitted to the CMOP facility "RTN","PSXRPPL2",137,0) ; because either a) a response from the payer was not received, or b) "RTN","PSXRPPL2",138,0) ; the Rx is non-billable. "RTN","PSXRPPL2",139,0) ; "RTN","PSXRPPL2",140,0) EPH ; - Store Rx not xmitted to CMOP in XTMP file for MailMan message. "RTN","PSXRPPL2",141,0) S ^TMP("PSXEPHIN",$J,$$RXSITE^PSOBPSUT(RXN),RXN)=RFL,EPHQT=1 "RTN","PSXRPPL2",142,0) Q "RTN","PSXRPPL2",143,0) ; "RTN","PSXRPPL2",144,0) ; ECMESTAT checks the Rx's ECME Status to determine if it's acceptable "RTN","PSXRPPL2",145,0) ; to resubmit based on reject codes associated with a previous "RTN","PSXRPPL2",146,0) ; submission. If Rx was rejected with host reject errors, and no other "RTN","PSXRPPL2",147,0) ; rejects exist, then it's OK to resubmit to ECME. "RTN","PSXRPPL2",148,0) ;Input: RX = Prescription file #52 IEN "RTN","PSXRPPL2",149,0) ; RFL = Refill number "RTN","PSXRPPL2",150,0) ;Returns: 1 = OK to resubmit "RTN","PSXRPPL2",151,0) ;0 = Don't resubmit "RTN","PSXRPPL2",152,0) ; "RTN","PSXRPPL2",153,0) ECMESTAT(RX,RFL) ; "RTN","PSXRPPL2",154,0) I '$$PATCH^XPDUTL("PSO*7.0*148") Q 0 "RTN","PSXRPPL2",155,0) N CHDAT,HERR,PSXECET,PSXIEN,PSXREJ,STATUS "RTN","PSXRPPL2",156,0) ; "RTN","PSXRPPL2",157,0) ; If an Open/Unresolved eC/eT reject on claim, don't resubmit "RTN","PSXRPPL2",158,0) I $$ECETREJ(RX) Q 0 "RTN","PSXRPPL2",159,0) ; "RTN","PSXRPPL2",160,0) S STATUS=$$STATUS^PSOBPSUT(RX,RFL) "RTN","PSXRPPL2",161,0) ; Never submitted before, OK to resubmit "RTN","PSXRPPL2",162,0) I STATUS=""!(STATUS["UNSTRANDED") Q 1 "RTN","PSXRPPL2",163,0) ; If status other than E REJECTED, don't resubmit "RTN","PSXRPPL2",164,0) I STATUS'="E REJECTED" Q 0 "RTN","PSXRPPL2",165,0) ; check for a previous host reject: "RTN","PSXRPPL2",166,0) ; 1 - if host reject date expired allow to print; 0 - if not expired don't print "RTN","PSXRPPL2",167,0) ; 2 - if not defined allow to continue with evaluation for new host reject "RTN","PSXRPPL2",168,0) S CHDAT=$$CHHEDT(RX,RFL) Q:CHDAT=1 1 Q:CHDAT=0 0 "RTN","PSXRPPL2",169,0) ;***************************************************************************************************** "RTN","PSXRPPL2",170,0) ; NOTE: MAKE SURE THAT IGNORED REJECTS WILL PROCESS WHENEVER MODIFICATIONS ARE MADE TO HOST REJECT "RTN","PSXRPPL2",171,0) ; Ignored rejects are handled by default when this subroutine Q 0 at the end. "RTN","PSXRPPL2",172,0) ;***************************************************************************************************** "RTN","PSXRPPL2",173,0) ; check host rejects "RTN","PSXRPPL2",174,0) S HERR=$$HOSTREJ(RX,RFL,0) "RTN","PSXRPPL2",175,0) I HERR&(CHDAT=2) D SHDTLOG(RX,RFL) Q 0 ;Host reject and no suspense hold date defined yet; define it and don't resubmit "RTN","PSXRPPL2",176,0) I HERR&(CHDAT) Q 1 ;Host reject & suspense hold date has expired; resubmit "RTN","PSXRPPL2",177,0) Q 0 ;NOTE - IF YOU CHANGE THIS Q 0, IGNORED REJECTS WILL RESUBMIT AND REJECT AGAIN WHICH IS VERY BAD. "RTN","PSXRPPL2",178,0) ; "RTN","PSXRPPL2",179,0) ; DSH determines whether a prescription has a 3/4 days supply hold "RTN","PSXRPPL2",180,0) ; condition. "RTN","PSXRPPL2",181,0) ; Input: REC = Pointer to Suspense file (#52.5) "RTN","PSXRPPL2",182,0) ; ACT = 1 or 0, indicating whether an entry should be made "RTN","PSXRPPL2",183,0) ; in the activity log if the 3/4 logic is bypassed. "RTN","PSXRPPL2",184,0) ; Returns: 1 or 0 "RTN","PSXRPPL2",185,0) ; 1 (one) if 3/4 of days supply has elapsed. "RTN","PSXRPPL2",186,0) ; 0 (zero) if 3/4 of days supply has not elapsed. "RTN","PSXRPPL2",187,0) ; "RTN","PSXRPPL2",188,0) DSH(REC,ACT) ;ePharmacy API to check for 3/4 days supply hold "RTN","PSXRPPL2",189,0) ; "RTN","PSXRPPL2",190,0) N COMM,DA,DAYSSUP,DIE,DR,DSHDT,DSHOLD "RTN","PSXRPPL2",191,0) N PREVRX,PSARR,PSINSUR,PSXCOMMENT,RFL,RXIEN,SDT,SFN,SHDT "RTN","PSXRPPL2",192,0) ; "RTN","PSXRPPL2",193,0) S DSHOLD=1 "RTN","PSXRPPL2",194,0) S RXIEN=$$GET1^DIQ(52.5,REC,.01,"I") "RTN","PSXRPPL2",195,0) S RFL=$$GET1^DIQ(52.5,REC,9,"I") "RTN","PSXRPPL2",196,0) I RFL="" S RFL=$$LSTRFL^PSOBPSU1(RXIEN) "RTN","PSXRPPL2",197,0) ; "RTN","PSXRPPL2",198,0) ; If the Rx/Fill is not e-billable, then Quit out. "RTN","PSXRPPL2",199,0) ; "RTN","PSXRPPL2",200,0) I '$$EBILLABLE^PSOSULB2(RXIEN,RFL) Q DSHOLD "RTN","PSXRPPL2",201,0) ; "RTN","PSXRPPL2",202,0) ; If the Bypass 3/4 Day Supply flag is set to "YES", then Quit with "RTN","PSXRPPL2",203,0) ; 1 after adding a comment to the Activity Log. "RTN","PSXRPPL2",204,0) ; "RTN","PSXRPPL2",205,0) I $$FLAG^PSOBPSU4(RXIEN,RFL)="YES" D Q DSHOLD ; ICR #7212 "RTN","PSXRPPL2",206,0) . I '$G(ACT) Q "RTN","PSXRPPL2",207,0) . S PSXCOMMENT="3/4 Day Supply logic bypassed during CMOP processing" "RTN","PSXRPPL2",208,0) . D RXACT^PSOBPSU2(RXIEN,RFL,PSXCOMMENT,"S",DUZ) "RTN","PSXRPPL2",209,0) . Q "RTN","PSXRPPL2",210,0) ; "RTN","PSXRPPL2",211,0) S DSHDT=$$DSHDT(RXIEN,RFL) ; 3/4 of days supply date "RTN","PSXRPPL2",212,0) S PREVRX=$P(DSHDT,U,2) "RTN","PSXRPPL2",213,0) S DSHDT=$P(DSHDT,U) "RTN","PSXRPPL2",214,0) I DSHDT>DT S DSHOLD=0 D "RTN","PSXRPPL2",215,0) . I DSHDT'=$$GET1^DIQ(52.5,REC,10,"I") D ; Update Suspense Hold Date and Activity Log "RTN","PSXRPPL2",216,0) . . ; If a previous Rx is used in the 3/4 days' supply calculation, "RTN","PSXRPPL2",217,0) . . ; capture that Rx in the activity log. "RTN","PSXRPPL2",218,0) . . S COMM="3/4 of Days Supply SUSPENSE HOLD until "_$$FMTE^XLFDT(DSHDT,"2D") "RTN","PSXRPPL2",219,0) . . I PREVRX'="" S COMM=COMM_" (prior Rx "_PREVRX_")" "RTN","PSXRPPL2",220,0) . . S COMM=COMM_"." "RTN","PSXRPPL2",221,0) . . S DAYSSUP=$$LFDS(RXIEN) "RTN","PSXRPPL2",222,0) . . D RXACT^PSOBPSU2(RXIEN,RFL,COMM,"S",+$G(DUZ)) ; Update Activity Log "RTN","PSXRPPL2",223,0) . . S DR="10///^S X=DSHDT",DIE="^PS(52.5,",DA=REC D ^DIE ; File Suspense Hold Date "RTN","PSXRPPL2",224,0) . . N DA,DIE,DR,PSOX,SFN,INDT,DEAD,SUB,XOK,OLD "RTN","PSXRPPL2",225,0) . . S DA=REC,DIE="^PS(52.5,",DR=".02///"_DSHDT D ^DIE "RTN","PSXRPPL2",226,0) . . S SFN=REC,DEAD=0,INDT=DSHDT D CHANGE^PSOSUCH1(RXIEN,RFL) "RTN","PSXRPPL2",227,0) . . Q "RTN","PSXRPPL2",228,0) . Q "RTN","PSXRPPL2",229,0) ; "RTN","PSXRPPL2",230,0) Q DSHOLD "RTN","PSXRPPL2",231,0) ; "RTN","PSXRPPL2",232,0) DSHDT(RXIEN,RFL) ; ePharmacy function to determine the 3/4 of the days supply date "RTN","PSXRPPL2",233,0) ; Input: RXIEN = Prescription file #52 ien "RTN","PSXRPPL2",234,0) ; RFL = fill# "RTN","PSXRPPL2",235,0) ; Returns: DATE value of last date of service plus 3/4 of days supply "RTN","PSXRPPL2",236,0) ; PREVRX = Previous Rx if PREVRX^PSOREJP2 identified one that "RTN","PSXRPPL2",237,0) ; should be used in the 3/4 days' supply calculation. "RTN","PSXRPPL2",238,0) ; "RTN","PSXRPPL2",239,0) N FILLDT,DAYSSUP,DSH34,PREVRX "RTN","PSXRPPL2",240,0) I '$D(^PSRX(RXIEN,0)) Q -1 "RTN","PSXRPPL2",241,0) I $G(RFL)="" Q -1 "RTN","PSXRPPL2",242,0) ; "RTN","PSXRPPL2",243,0) D PREVRX^PSOREJP2(RXIEN,RFL,,.FILLDT,.DAYSSUP,.PREVRX) "RTN","PSXRPPL2",244,0) I FILLDT="" Q -1 "RTN","PSXRPPL2",245,0) ; "RTN","PSXRPPL2",246,0) S DSH34=DAYSSUP*.75 ; 3/4 of Days Supply "RTN","PSXRPPL2",247,0) S:DSH34["." DSH34=(DSH34+1)\1 "RTN","PSXRPPL2",248,0) ; Return last date of service plus 3/4 of Days Supply date "RTN","PSXRPPL2",249,0) ; and the previous Rx used in the calculation, if any. "RTN","PSXRPPL2",250,0) Q $$FMADD^XLFDT(FILLDT,DSH34)_U_PREVRX "RTN","PSXRPPL2",251,0) ; "RTN","PSXRPPL2",252,0) ; LFDS returns the DAYS SUPPLY for the latest fill for a prescription. "RTN","PSXRPPL2",253,0) ; Input: RXIEN = Prescription file #52 IEN "RTN","PSXRPPL2",254,0) ; Returns: DAYS SUPPLY for the latest fill "RTN","PSXRPPL2",255,0) ; -1 if RXIEN is not valid "RTN","PSXRPPL2",256,0) LFDS(RXIEN) ; "RTN","PSXRPPL2",257,0) N RXFIL "RTN","PSXRPPL2",258,0) Q:'$D(^PSRX(RXIEN)) -1 "RTN","PSXRPPL2",259,0) S RXFIL=$$LSTRFL^PSOBPSU1(RXIEN) "RTN","PSXRPPL2",260,0) Q $S(RXFIL=0:$P(^PSRX(RXIEN,0),U,8),1:$P(^PSRX(RXIEN,1,RXFIL,0),U,10)) "RTN","PSXRPPL2",261,0) ; "RTN","PSXRPPL2",262,0) ; DUR checks for host errors and the suspense hold date. "RTN","PSXRPPL2",263,0) ; Input: "RTN","PSXRPPL2",264,0) ; RX = Prescription file #52 IEN "RTN","PSXRPPL2",265,0) ; RFL = Refill number "RTN","PSXRPPL2",266,0) ; Returns: A value of 0 (zero) will be returned when reject code M6, "RTN","PSXRPPL2",267,0) ; M8, NN, or 99 are present OR if on susp hold which means the "RTN","PSXRPPL2",268,0) ; prescription should not be sent to CMOP. "RTN","PSXRPPL2",269,0) ; Otherwise, a value of 1(one) will be returned. "RTN","PSXRPPL2",270,0) DUR(RX,RFL) ; "RTN","PSXRPPL2",271,0) N REJ,IDX,TXT,CODE,SHCODE,SHDT,CHDAT1 "RTN","PSXRPPL2",272,0) S IDX="" "RTN","PSXRPPL2",273,0) I '$D(RFL) S RFL=$$LSTRFL^PSOBPSU1(RX) "RTN","PSXRPPL2",274,0) ; "RTN","PSXRPPL2",275,0) ; check for a previous host reject: "RTN","PSXRPPL2",276,0) ; 0 - host reject date not expired; don't print "RTN","PSXRPPL2",277,0) ; 1 - host reject date expired; allow to print "RTN","PSXRPPL2",278,0) ; 2 - host reject not define; allow to continue with evaluation "RTN","PSXRPPL2",279,0) ; for new host reject "RTN","PSXRPPL2",280,0) S CHDAT1=$$CHHEDT(RX,RFL) "RTN","PSXRPPL2",281,0) I CHDAT1=1 Q 1 "RTN","PSXRPPL2",282,0) I CHDAT1=0 Q 0 "RTN","PSXRPPL2",283,0) ; "RTN","PSXRPPL2",284,0) ; If a host reject exists and no previous Susp Hold Date or log entry, "RTN","PSXRPPL2",285,0) ; create the log entry and hold rx/fill. "RTN","PSXRPPL2",286,0) S HERR=$$HOSTREJ(RX,RFL,1) "RTN","PSXRPPL2",287,0) I HERR,SHDT="" D SHDTLOG(RX,RFL) "RTN","PSXRPPL2",288,0) I HERR Q 0 "RTN","PSXRPPL2",289,0) Q 1 "RTN","PSXRPPL2",290,0) ; "RTN","PSXRPPL2",291,0) CHHEDT(RX,RFL) ; "RTN","PSXRPPL2",292,0) ; RX = Prescription File IEN "RTN","PSXRPPL2",293,0) ; RFL = Refill "RTN","PSXRPPL2",294,0) ;Returns: "RTN","PSXRPPL2",295,0) ; 0 = host reject date not expired "RTN","PSXRPPL2",296,0) ; 1 = host reject has expired "RTN","PSXRPPL2",297,0) ; 2 = host reject not defined "RTN","PSXRPPL2",298,0) ; "RTN","PSXRPPL2",299,0) S SHDT=$$SHDT(RX,RFL) ; Get suspense hold date for rx/refill "RTN","PSXRPPL2",300,0) I SHDT'="" Q:DT'