| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | ncpdp reject code(+) | 0;1 | FREE TEXT | B | NCPDP Reject Code that indicates the reason for the claim rejection for this prescription. | |
| 1 | date/time detected | 0;2 | DATE-TIME | Date/Time when the reject was detected by Outpatient Pharmacy. | ||
| 2 | payer message | 1;1 | FREE TEXT | Message from the 3r party payer regarding the rejection of the claim. | ||
| 3 | reason | 1;2 | FREE TEXT | Reason why the claim is being rejected by the 3rd party payer. | ||
| 4 | pharmacist | 0;3 | POINTER | 200 | Pharmacist using the application when the reject was detected. | |
| 5 | fill number | 0;4 | NUMERIC | This field is used to indicate which fill the reject is related to. | ||
| 6 | group name | 2;1 | FREE TEXT | This is the patient's insurance group name. | ||
| 7 | plan contact | 2;2 | FREE TEXT | This is the patient's insurance company contact information. | ||
| 8 | plan previous fill date | 2;3 | DATE-TIME | In case of a REFILL TOO SOON reject (#79) and the payer returns the last date the prescription was filled, it will be stored on this field. | ||
| 9 | status | 0;5 | SET OF CODES | 0:OPEN/UNRESOLVED 1:CLOSED/RESOLVED | This field indicates whether the reject is OPEN/UNRESOLVED or CLOSED/RESOLVED. | |
| 10 | closed date/time | 0;6 | DATE-TIME | Date/Time when the reject was marked CLOSED/RESOLVED. | ||
| 11 | closed by | 0;7 | POINTER | 200 | User responsible for marking the reject CLOSED/RESOLVED. | |
| 12 | close reason | 0;8 | SET OF CODES | 1:CLAIM RE-SUBMITTED 2:RX ON HOLD 3:RX SUSPENDED 4:RX RETURNED TO STOCK 5:RX DELETED 6:IGNORED - NO RESUBMISSION 7:RX DISCONTINUED 8:RX EDITED 99:OTHER | This field indicates the reason for marking the reject CLOSED/RESOLVED. | |
| 13 | close comments | 3;1 | FREE TEXT | User entered comments. | ||
| 14 | reason for service code | 0;9 | FREE TEXT | NCPDP field indicating the resason for service code. See NCPDP REASON FOR SERVICE CODE file (#9002313.23) for possible values. | ||
| 15 | professional service code | 0;10 | FREE TEXT | NCPDP field indicating the professional service code. See NCPDP PROFESSIONAL SERVICE CODE file (#9002313.21) for possible values. | ||
| 16 | response id | 0;11 | NUMERIC | This field is used to make sure the reject is recorded only once. | ||
| 17 | other rejects | 0;12 | FREE TEXT | List of other reject codes that were returned at the same time. | ||
| 18 | dur text | 4;1 | FREE TEXT | In case of a DUR reject (#88) the 3rd party payer returns an explanation of the DUR (Drug Usability Review). | ||
| 19 | result of service code | 0;13 | FREE TEXT | NCPDP field indicating the result of service code. See NCPDP RESULT OF SERVICE CODE file (#9002313.22) for possible values. | ||
| 20 | insurance name | 2;4 | FREE TEXT | Patient's insurance company name. | ||
| 21 | group number | 2;5 | FREE TEXT | Patient's insurance group number. | ||
| 22 | cardholder id | 2;6 | FREE TEXT | ID number assigned to Cardholder/Subscriber. | ||
| 23 | re-opened | 0;14 | BOOLEAN | 1:YES | This flag indicates that the user has manually re-opened another reject and this one was created. | |
| 24 | clarification code | 0;15 | FREE TEXT | This field contains up to 3 NCPDP Clarification Codes for the reject. Clarification codes are copied from the CODE (#.01) field of the BPS NCPDP CLARIFICATION CODES (#9002313.25) file. | ||
| 25 | prior authorization type | 0;16 | NUMERIC | This is the Prior Authorization Type that will be sent to ECME and placed in NCPDP field 461-EU (Prior Authorization Type) on the NCPDP claim that is sent to the third-party payer. | ||
| 26 | prior authorization number | 0;17 | NUMERIC | NCPDP Prior Authorization Number. This field may be left blank if the claim does not require a number. | ||
| 27 | coordination of benefits | 2;7 | SET OF CODES | 1:PRIMARY 2:SECONDARY 3:TERTIARY | This field contains the Coordination of Benefits indicator for the third party insurance rejection for the fill. | |
| 28 | dur add msg text | 5;1 | FREE TEXT | In case of a DUR reject (#88) the 3rd party payer may return additional text in the DUR Additional Message NCPDP field (570-NS). | ||
| 29 | bin | 2;8 | FREE TEXT | Card Issuer ID or Bank ID Number used for network routing. | ||
| 30 | rrr flag | 0;18 | BOOLEAN | 1:YES 0:NO | The Reject Resolution Required (RRR) Flag is used to indicate that priority action is required to resolve the rejected ECME claim in the Third Party Rejects Worklist. The flag is used only for Veteran Eligibility claims where the value of the claim is at or above a site specified threshold. RRR rejects are displayed in a separate 'Reject Resolution Required' section of the Third Party Rejects Worklist. | |
| 31 | rrr dollar threshold | 0;19 | NUMERIC | This is the value of the 'DOLLAR THRESHOLD' (#.02) field of the RESOLUTION REQUIRED REJ CODE (#52.865) subfile of the EPHARMACY SITE PARAMETERS (#52.86) file. It is the dollar threshold value at the time of the prescription processing through the ePharmacy system in which the reject was flagged as a Resolution Required Reject code. | ||
| 32 | rrr gross amount due | 0;20 | NUMERIC | If this rejection is flagged as a Reject Resolution Required reject, then this field is the gross amount due of the prescription. The value is copied from the GROSS AMOUNT DUE (#902.15) field of the PATIENT INSURANCE MULTIPLE (#9002313.59902) subfile of the BPS TRANSACTION (#9002313.59) file. | ||
| 51 | comments | COM;0 | MULTIPLE | 52.2551 |
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