Files > PLAN

name

PLAN

number

366.03

location

^IBCNR(366.03,

description

This Integrated Billing (IB) file was created for the e-Pharmacy Project. It is maintained centrally, via real time HL7 Table Update Messages, using the WebMD database. Never maintain locally, except via a designated and secured option that edits selected APPLICATION Subfile fields, such as LOCAL ACTIVE?. A Plan is a Payer's medical health care insurance product that defines benefits and their delivery to organizations and individuals that enroll in the Plan. A Plan is uniquely identified by its' identifier (VA National Plan ID). Per VHA Directive 10-93-142, this file definition should not be modified.

Fields

#	Name	Location	Type	Details	Index	Description
.01	id(+)	0;1	FREE TEXT		B	The Plan's identifier (ID / VA National Plan ID).
.02	name(+)	0;2	FREE TEXT		C	The Plan's long name (VA National Plan Name).
.03	payer name	0;3	POINTER	365.12		The Plan's Payer Name.
.04	name - short	0;4	FREE TEXT			The Plan's short name.
.05	type	0;5	SET OF CODES	BC:Blue Cross CO:Commercial TC:TRICARE UC:Uncategorized		The Plan's type code.
.06	region	0;6	FREE TEXT			The Plan's geographical region (e.g. MD).
.07	date/time created(+)	0;7	DATE-TIME			The date and time associated with the creation of Plan file (#366.03) entry.
1.01	primary contact name	1;1	FREE TEXT			The Plan's primary contact name in general VA name format (Family,Given Middle/MI Suffix).
1.02	primary contact prefix	1;2	FREE TEXT			The Plan's primary contact prefix / title (e.g. Dr.).
1.03	primary contact degree	1;3	FREE TEXT			The Plan's primary contact degree code (e.g. MD).
1.04	alternate contact name	1;4	FREE TEXT			The Plan's alternate contact name in general VA name format (Family,Given Middle/MI Suffix).
1.05	alternate contact prefix	1;5	FREE TEXT			The Plan's alternate contact prefix / title (e.g. Dr.).
1.06	alternate contact degree	1;6	FREE TEXT			The Plan's alternate contact degree code (e.g. MD).
2	contact means	2;0	MULTIPLE	366.032		The Plan's Contact Means sub-file. Applies to both the Plan's primary and alternate contacts.
3	application	3;0	MULTIPLE	366.033		The Plan's Application (electronic interface application) sub-file.
10.01	pharmacy benefits manager name	10;1	POINTER	366.02		The Plan's Pharmacy Benefits Manager (PBM) Name.
10.02	banking identification number	10;2	FREE TEXT		D	The Plan's Banking Identification Number (BIN). Used for NCPDP transmissions.
10.03	processor control number (pcn)	10;3	FREE TEXT		E	The Plan's Processor Control Number (PCN). Used for NCPDP transmissions.
10.04	ncpdp processor name	10;4	POINTER	366.01		The Plan's NCPDP Processor Name.
10.05	enabled?	10;5	BOOLEAN	0:No 1:Yes		Is the Plan enabled for NCPDP transmissions?
10.06	software vendor id	10;6	FREE TEXT			The Plan's software vendor / certification identifier (ID). Used for NCPDP transmissions.
10.07	billing payer sheet name	10;7	POINTER	9002313.92		The Plan's Billing Payer Sheet Name. Defines the NCPDP Billing (B1) Record format.
10.08	reversal payer sheet name	10;8	POINTER	9002313.92		The Plan's Reversal Payer Sheet Name. Defines the NCPDP Reversal (B2) Record format.
10.09	rebill payer sheet name	10;9	POINTER	9002313.92		The Plan's Rebill Payer Sheet Name. Defines the NCPDP Rebill (B3) Record format.
10.1	maximum ncpdp transactions	10;10	NUMERIC			The Plan's maximum NCPDP transactions permitted within an NCPDP transmission.
10.11	test billing payer sheet	10;11	POINTER	9002313.92		The Plan's Test Billing Payer Sheet Name. Defines the Test NCPDP Billing (B1) Record format.
10.12	test reversal payer sheet name	10;12	POINTER	9002313.92		The Plan's Test Reversal Payer Sheet Name. Defines the Test NCPDP Reversal (B2) Record format.
10.13	test rebill payer sheet name	10;13	POINTER	9002313.92		The Plan's Test Rebill Payer Sheet Name. Defines the Test NCPDP Rebill (B3) Record format.
10.14	test eligibility sheet name	10;14	POINTER	9002313.92		This is the Plan's Test Eligibility Verification Payer Sheet Name, which gives the specifications for a Eligibility Verification request sent for this plan. This payer sheet is manually entered by the user to override the normal Eligibility Payer sheet in the ELIGIBILITY PAYER SHEET NAME (#10.15) field and is used when the site needs to use a payer sheet other than the 'standard' one.
10.15	eligibility payer sheet name	10;15	POINTER	9002313.92		This is the Plan's Eligibility Verification Payer Sheet Name, which gives the specifications for a Eligibility Verification request sent for this plan.
11.01	rx primary contact name	11;1	FREE TEXT			The Plan's pharmacy (RX) primary contact name in general VA name format (Family,Given Middle/MI Suffix).
11.02	rx primary contact prefix	11;2	FREE TEXT			The Plan's pharmacy (RX) primary contact prefix / title (e.g. Dr.).
11.03	rx primary contact degree	11;3	FREE TEXT			The Plan's pharmacy (RX) primary contact degree code (e.g. MD).
11.04	rx alternate contact name	11;4	FREE TEXT			The Plan's pharmacy (RX) alternate contact name in general VA name format (Family,Given Middle/MI Suffix).
11.05	rx alternate contact prefix	11;5	FREE TEXT			The Plan's pharmacy (RX) alternate contact prefix / title (e.g. Dr.).
11.06	rx alternate contact degree	11;6	FREE TEXT			The Plan's pharmacy (RX) alternate contact degree code (e.g. MD).
12	rx contact means	12;0	MULTIPLE	366.0312		The Plan's Pharmacy (RX) Contact Means sub-file. Applies to both the Plan's pharmacy (RX) primary and alternate contacts.