Files > INSURANCE

parent

366.141

name

INSURANCE

number

366.1412

Fields

#	Name	Location	Type	Details	Index	Description
.01	insurance	0;1	NUMERIC		B	Sequential number for patients insurances.
.02	group insurance plan	0;2	POINTER	355.3		Group Insurance Plan
.03	bin	0;3	FREE TEXT			Bank Identification Number
.04	pcn	0;4	FREE TEXT			Processor Control Number
.05	payer sheet b1	0;5	FREE TEXT			Payer sheet B1
.06	group id	0;6	FREE TEXT			Group ID
.07	cardholder id	0;7	FREE TEXT			Cardholder ID
.08	patient relationship code	0;8	NUMERIC			Patient Relationship code
.09	pharmacy person code	0;9	FREE TEXT			This is the pharmacy person code value at the time of IB billing determination. This field is stored and maintained with the patient insurance policy data. This is the code that is assigned by the payer to identify the patient. The payer may use a unique person code to identify each specific person on the pharmacy insurance policy. This code may also describe the patient's relationship to the cardholder. Enrollment Standard Examples: 001 = Cardholder 002 = Spouse 003 - 999 = Dependents and Others (including second spouses, etc.)
.101	cardholder first name	1;1	FREE TEXT			Cardholder First Name
.102	cardholder last name	1;2	FREE TEXT			Cardholder Last Name
.103	state	1;3	POINTER	5		State
.104	payer sheet b2	1;4	FREE TEXT			Payer sheet B2
.105	payer sheet b3	1;5	FREE TEXT			Payer sheet B3
.106	software/vendor cert id	1;6	FREE TEXT			Software/Vendor Certification ID
.107	insurance name	1;7	FREE TEXT			Insurance Name
.201	dispensing fee	2;1	NUMERIC			Dispensing Fee Submitted
.202	basis of cost determination	2;2	FREE TEXT			Basis of Cost Determination
.203	awp or tort rate or cost	2;3	NUMERIC			Average Wholesale Price OR Tort dollar amount rate OR Cost amount
.204	gross amount due	2;4	NUMERIC			Gross Amount Due. Base price plus Dispense fee/Administrative fee.
.205	administrative fee	2;5	NUMERIC			Administrative Fee
.206	ingredient cost	2;6	NUMERIC			The ingredient cost is the calculation of quantity times unit price. No fees included.
.207	usual and customary charge	2;7	NUMERIC			Usual & Customary Charges. Gross Amount Due less the administrative fees.
.301	group name	3;1	FREE TEXT			Group Name
.302	insurance phone number	3;2	FREE TEXT			Insurance Phone Number
.303	plan id	3;3	FREE TEXT			Plan ID
.304	pt insurance policy	3;4	NUMERIC			This is the insurance policy at the time of IB billing determination. This is the internal entry number to the 2.312 subfile of the PATIENT (#2) file.