| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | refill date | 0;1 | DATE-TIME | B | This is the date the prescription is refilled. | |
| 1 | qty(+) | 0;4 | NUMERIC | |||
| 1.1 | days supply(+) | 0;10 | NUMERIC | This field is used to show days of supply of refill. | ||
| 1.2 | current unit price of drug | 0;11 | NUMERIC | This field is used to show the current unit cost of the drug at time of refill. | ||
| 2 | mail/window(+) | 0;2 | SET OF CODES | M:MAIL W:WINDOW | This field contains 'M' if the refill is to be mailed to the patient and 'W' if the refill is to be picked up at the pharmacy window. | |
| 3 | remarks | 0;3 | FREE TEXT | This field contains comments as deemed necessary by the pharmacy staff. | ||
| 4 | pharmacist name | 0;5 | POINTER | 200 | This field contains the name of the pharmacist responsible for this Rx. | |
| 5 | lot # | 0;6 | FREE TEXT | This field contains the lot # of the prescription. | ||
| 6 | clerk code(+) | 0;7 | POINTER | 200 | This field contains the NEW PERSON File entry number of the clerk. | |
| 7 | login date | 0;8 | DATE-TIME | This is the date the refill request was entered. | ||
| 8 | division(+) | 0;9 | POINTER | 59 | This field contains the Pharmacy Division associated with this Rx. | |
| 9 | ib number | IB;1 | POINTER | 350 | This field contains the internal entry number of the pointer to the Integrated Billing Action file (#350). | |
| 9.1 | copay exceeding cap | IB;2 | POINTER | 354.71 | This field contains the internal entry number of the pointer to the IB COPAY TRANSACTIONS file (#354.71). There will only be data in this field if this Rx's copay exceeded the annual copay cap. | |
| 10.1 | dispensed date(+) | 0;19 | DATE-TIME | This field is used to show date/time the medication was placed into packaging. | ||
| 11 | ndc | 1;3 | FREE TEXT | This field is used for the National Drug Code for the issued drug. | ||
| 12 | manufacturer | 0;14 | FREE TEXT | This field is used to show the manufacturer of the drug issued. | ||
| 13 | drug expiration date | 0;15 | DATE-TIME | This field is used to show the date that the medication expires for this refill. | ||
| 14 | returned to stock | 0;16 | DATE-TIME | This field is used to indicate when and if the medication was returned to inventory due to the prescription not being picked up or mailed to the patient. | ||
| 15 | provider(+) | 0;17 | POINTER | 200 | This field is used to show the current provider seeing the patient. | |
| 16 | generic provider | 1;1 | FREE TEXT | This field is used to show a provider outside of the medical center. | ||
| 17 | released date/time | 0;18 | DATE-TIME | This field is used to show the date/time the medication was released for inventory purposes and copay billing if applicable. | ||
| 18 | bingo wait time | 1;2 | NUMERIC | This field specifies, in minutes, the total wait time for bingo board purposes. | ||
| 19 | filling person | 1;4 | POINTER | 200 | The name of the person who scanned the barcode before refilling the medication request. | |
| 20 | checking pharmacist | 1;5 | POINTER | 200 | The name of the pharmacist that checked the medication refill request. | |
| 21 | pfss account reference | PFS;1 | POINTER | 375 | This is a reference number to an external medical billing system Account Number for the purposes of uniquely identifying prescription charges for 1st or 3rd party billing. | |
| 22 | pfss charge id | PFS;2 | NUMERIC | This is another unique identifier required when prescription charge messages are passed to the external billing system. | ||
| 23 | administered in clinic | 0;20 | BOOLEAN | 1:YES | This indicates if the medication was administered in a clinic instead of being dispensed to the patient. | |
| 81 | daw code | EPH;1 | FREE TEXT | Dispensed As Written code. This information is used for NCPDP electronic claim transmission to third party payers (insurance companies). | ||
| 82 | re-transmit flag | EPH;2 | BOOLEAN | 1:YES | This field is used to indicate that a claim should be electronically re-transmitted to the 3rd party insurance. It will be primarily used by CMOP and local mail prescriptions. | |
| 83 | date ndc validated | EPH;3 | DATE-TIME | This field contains the date and time that the NDC was validated prior to release of the prescription fill. | ||
| 84 | ndc validated by | EPH;4 | POINTER | 200 | This field contains the user ID of the person who validated the NDC prior to release of the prescription fill. | |
| 85 | billing eligibility indicator | EPH;5 | SET OF CODES | T:TRICARE V:VETERAN C:CHAMPVA | This field is set when a prescription is third party insurance billable and will contain T for TRICARE, V for VETERAN or C for CHAMPVA. | |
| 86 | epharmacy suspense hold date | EPH;6 | DATE-TIME | This field is defined when a host reject error is received as a result of an ePharmacy claims submission. The prescription fill will be held on suspense until the next day. |
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