| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | prescription number(+) | 0;1 | FREE TEXT | AB | This is a reference number assigned by a pharmacy provider for a prescription. | |
| 1 | drug name(+) | 0;2 | FREE TEXT | This is the name of the medication that was dispensed to the patient by the FEE provider. | ||
| 1.4 | manufacturer | 2;2 | FREE TEXT | This is the name of the company whose drug was dispensed to the patient. | ||
| 1.5 | strength | 0;12 | FREE TEXT | This field contains the labeled strength of the medication dispensed to the patient. | ||
| 1.6 | quantity(+) | 0;13 | FREE TEXT | This is the total number of units dispensed to the patient. | ||
| 2 | date prescription filled(+) | 0;3 | DATE-TIME | This is the date the provider has filled the prescription for dispensing to the patient. | ||
| 3 | amount claimed(+) | 0;4 | NUMERIC | This is the dollar amount claimed by the FEE provider for the prescription supplied to the patient. | ||
| 4 | patient(+) | 0;5 | POINTER | 161 | C | This is the name of the patient whose prescription/s are being submitted by the FEE provider for payment. |
| 5 | red book cost | 0;6 | NUMERIC | This is the cost of the generic drug dispensed to the patient as listed in the 'RED BOOK'. | ||
| 6 | amount suspended | 0;7 | NUMERIC | This is the difference between the amount claimed by the FEE provider and the amount paid by the VA. | ||
| 6.5 | amount paid | 0;16 | NUMERIC | This field is either the amount claimed by the FEE provider or the sum of RED BOOK cost and the professional dispensing fee - whichever is less. | ||
| 7 | suspend code | 0;8 | POINTER | 161.27 | This is the explanation why the amount claimed by the FEE provider is not the same as the amount paid.These codes are listed in M-1,Part I,Chapter 18,Appendix A for reference. | |
| 8 | line item status(+) | 0;9 | SET OF CODES | 1:PENDING PHARMACY DETERMINATION 2:PENDING MAS COMPLETION 3:PENDING PAYMENT PROCESS 4:COMPLETED 0:COMPLETED, WILL NOT PAY | AC | This tells the current status of review of this line item within the invoice. |
| 8.5 | substitute generic drug | 0;21 | BOOLEAN | Y:YES N:NO | This field shows if a generic drug was or could have been dispensed to the patient. | |
| 9 | generic drug(+) | 0;10 | POINTER | 50 | This is the name of the generic equivalent found in the VA drug file that was dispensed to the patient. | |
| 10 | pharmacy determination | 0;11 | SET OF CODES | 1:APPROVED FOR PAYMENT 0:DISAPPROVED FOR PAYMENT | This is a professional determination by the VA pharmacist to determine if the medication dispensed was for an authorized condition and whether or not the drug is on the 'inactive drug list' . | |
| 11 | pharmacist | 0;14 | POINTER | 200 | This is the name of the VA pharmacist who reviewed the patient's prescriptions for appropriateness. | |
| 12 | date of determination | 0;15 | DATE-TIME | This is the date the VA pharmacist reviewed the prescriptions for appropriateness of payment. | ||
| 13 | batch number(+) | 0;17 | POINTER | 161.7 | AE | This is the Batch number associated with this line item for payment. |
| 14 | obligation number(+) | 0;18 | FREE TEXT | This is the account from which the money is taken to pay the line item. | ||
| 15 | date certified for payment | 0;19 | DATE-TIME | This is the date that the line item has been approved, by FEE, for payment. | ||
| 16 | payment type code | 0;20 | SET OF CODES | V:VENDOR R:REIMBURSEMENT S:STATISTICAL SR:STAT-REIMBURSEMENT | This field represents what type of payment this line item is. The choices are payment to a Vendor, patient Reimbursement or paid 'out-of-system' for Statistical and stat reimbursement reporting. | |
| 17 | reject status | FBREJ;1 | SET OF CODES | P:REJECTED, PENDING C:REJECTED, COMPLETED | This field represents the status of the Rejected line item in the invoice. It would either be Pending or Completed. | |
| 18 | reject reason | FBREJ;2 | FREE TEXT | This is a free text field that allows comment on why Fee rejected this line item payment. | ||
| 19 | old batch number | FBREJ;3 | POINTER | 161.7 | AF | When a line item was rejected then assigned to a new batch this field stores the old batch number it belonged to. |
| 19.3 | interface reject | FBREJ;4 | BOOLEAN | 1:YES | This field is populated by the FBAA BATCH SERVER and FBAA REJECT SERVER server options when a payment line item is rejected via the interface with Central Fee. This field is used to distinguish line items that were locally rejected from those that were rejected by a downstream system. This field is not populated for a local reject. | |
| 19.6 | reject code | FBREJC;0 | MULTIPLE | 162.111 | The REJECT CODE multiple is populated with one to four reject codes by the FBAA BATCH SERVER and FBAA REJECT SERVER server options when a line item is rejected via the interface with Central Fee. The REJECT CODE multiple is not used for local rejects. The reason for a local reject is entered into the REJECT REASON (#18) field. | |
| 20 | suspension description | 1;0 | WORD-PROCESSING | This field allows the entry of a description of why the amount claimed for a prescription is not the same as the amount paid . | ||
| 21 | generic drug only status | 2;1 | SET OF CODES | P:PENDING | AH | This field reflects whether or not pharmacy has made the match with the drug dispensed in the VA Drug File. |
| 22 | pharmacy remarks | 0;22 | FREE TEXT | This allows pharmacy service to enter in remarks on their decision for payment of the prescription. | ||
| 23 | void payment | 2;3 | SET OF CODES | V:VOID | This field shows if a Fee supervisor voided this payment after the invoice had been completed. | |
| 23.5 | reason for voided payment | R;1 | FREE TEXT | This field is used by the supervisor to enter a reason why a payment had to be voided. | ||
| 24 | supervisor | 2;4 | POINTER | 200 | This field stores the supervisor who voided a payment. | |
| 25 | primary service facility | 2;5 | POINTER | 4 | The VA Hospital responsible for the veterans care. | |
| 26 | associated 7078/583 | 2;6 | VARIABLE-POINTER | 162.4, 162.7 | AO | This field contains the related 7078 or 583 if an unauthorized claim. |
| 27 | authorization pointer | 2;7 | NUMERIC | This field is set internally to the patient's authorization in the Fee Basis Patient file. It is used to display only the authorization associated with the prescription to the pharmacist during their review. | ||
| 28 | date paid | 2;8 | DATE-TIME | This is the date of the check, as issued by the treasury. This information will be passed back to DHCP from the Financial Management System (FMS) when the check is issued to the vendor. This field will use the check date beginning with version 3.5 of Fee Basis. | ||
| 29 | prompt pay type | 2;9 | SET OF CODES | 1:MONEY MANAGED | Field is set to 1 if the payment is subject to interest payments (prompt pay). Otherwise it remains blank. | |
| 30 | check number | 2;10 | FREE TEXT | Contains the check number as issued by the treasury. This field is updated after the check is issued, through a server option that records actual payment information for each Fee payment made. | ||
| 31 | cancellation date | 2;11 | DATE-TIME | This is the date the treasury cancelled the check. This field is updated through a server option that records cancellations of previously recorded payment data. | ||
| 32 | reason code | 2;12 | POINTER | 162.95 | This field contains a pointer to the Fee Basis Check Cancellation Reason file. It is populated through a server option that updates the payment record when the treasury cancels a check that was previously payed. | |
| 33 | cancellation activity | 2;13 | SET OF CODES | R:WILL BE REPLACED C:WILL BE REISSUED X:WILL NOT BE REISSUED | This field is populated when a cancellation is recorded for the payment referenced. This field will always remain populated, to indicate that there was cancellation activity on this payment at one time. New payments will replace the cancellation date and reason code fields, but the cancellation activity flag will not be overwritten. This flag will allow the user to know that previous cancellation activity existed, and to review the cancellation history output for further information. | |
| 34 | disbursed amount | 2;14 | NUMERIC | This is the dollar amount paid by the treasury, less any interest paid. | ||
| 35 | interest amount | 2;15 | NUMERIC | The interest amount paid on this line item by the treasury. | ||
| 36 | fpps line item | 3;1 | FREE TEXT | Enter the line item sequence number associated with this charge. Each charge on the FPPS invoice document will have a line item sequence number associated with it. A line item can be entered individually or a group of charges from multiple lines can be entered. If all line items in a group are in numerical sequence, you may enter the first line item sequence number followed by a hyphen and the last line item sequence number. If the grouped charges are not in sequential order, each line item must be entered individually, followed by a comma. | ||
| 37 | adjustment | 4;0 | MULTIPLE | 162.14 | ||
| 38 | remittance remark | 5;0 | MULTIPLE | 162.15 | ||
| 39 | dod invoice number | 6;1 | FREE TEXT | DODI | This is the DoD invoice number that is found in box 3a on the UB04 form or box 26 on the CMS 1500 form. |
Error: Invalid Global File Type: 162.11