Intermediate form of transmissions. Fields are stored in formatted form. Raw packet is also stored. Most fields are in Free Text format to accommodate NCPDP Standard formatting criteria and required field lengths. Fields other than those with decimals in the number correlate directly to the field numbers supplied in the NCPDP Data Dictionary. While many of the fields in this file indicate coded values, they are NCPDP coded values preceded by the NCPDP field identifier to be used in the NCPDP transmission. Example: Compound Code is either a 1 or 0. The NCPDP field identifier for 'Compound Code' is 'D6'. The field length is 3 thereby allowing the identifier for that field to be included in the data stored in that field. So, 'D61' is stored for that field. Per VHA Directive 2004-038, this file definition should not be modified.
.01claim id0;1FREE TEXTExternal Claim ID value. This value is a concatenation of the text 'VA' along with the current year, the pharmacy ID, the VA National Plan ID (without the alpha prefix), and a unique sequence number. Each of the four pieces is delimited by the equal sign ("=").
.02electronic payer0;2POINTER9002313.92This is the payer sheet used by the claim
.04transmit flag0;4SET OF CODES1:YES (BATCH FILE)
ADNumerical code to indicate a transmit status. Current values are 0 for 'No' 1 for 'Yes' Batch and 2 for 'Yes' Point of Sale.
.05transmitted on0;5DATE-TIMEAEDate on which the data was transmitted.
.06created on0;6DATE-TIMEDate on which this record was created.
.07auto reverse flag0;7SET OF CODES0:NO
This flag is marking ECME Claims that were automatically reversed because the Prescription was not released in time or the claim was an inpatient claim.
.08transaction0;8POINTER9002313.59This is the ECME transaction that generates the claim.
1.01patient name1;1FREE TEXTCPatient name extracted from the VA patient file. This entry is free text to accommodate the NCPDP formatting requirements.
1.04group insurance plan1;4POINTER355.3Internal identifier number for the Group Insurance Record
101bin number100;1FREE TEXTCard Issuer ID or Bank ID Number used for network routing.
102version release number100;2FREE TEXTCode identifying the Enrollment Standard format of the file sent or received.
103transaction code100;3FREE TEXTCode to identify the transaction type for this claim. E1=Eligibility Verification B1=Billing B2=Reversal B3=Rebill P1=P.A. Request & Billing P2=P.A. Reversal P3=P.A. Inquiry P4=P.A. Request Only N1=Information Reporting N2=Information Reporting Reversal N3=Information Reporting Rebill C1=Controlled Substance Reporting C2=Controlled Substance Reporting Reversal C3=Controlled Substance Reporting Rebill
104processor control number100;4FREE TEXTNumber which will uniquely identify the submitter of the claim. NCPDP field 104-A4.
109transaction count100;9FREE TEXTCount of transactions in the transmission. NCPDP standard field 109-A9.
110software vender cert id100;10FREE TEXTCertification number which Identifies the patient's insurance carrier. NCPDP standard field 110-AK.
114medicaid subrogation icn/tcn110;4FREE TEXTThis is used to store NCPDP field 114-N4 (Medicaid Subrogation Internal Control Number/Transaction Control Number (ICN/TCN)), which is defined as "Claim number assigned by the Medicaid Agency."
115medicaid id number110;5FREE TEXTThis is used to store NCPDP field 115-N5 (Medicaid ID Number), which is defined as "A unique member identification number assigned by the Medicaid Agency."
116medicaid agency number110;6FREE TEXTThis is used to store NCPDP field 116-N6 (Medicaid Agency Number), which is defined as "Number assigned by processor to identify the individual Medicaid Agency or representative."
201service provider id200;1FREE TEXTID assigned to a pharmacy or provider. NCPDP standard field 201-B1.
202service provider id qual200;2FREE TEXTQualifier indicating which ID number was used. NCPDP standard field 202-B2.
301group id300;1FREE TEXTID assigned to the cardholder group or employer group. NCPDP standard field 301-C1.
302cardholder id300;2FREE TEXTInsurance ID assigned to the cardholder or identification number used by the plan. NCPDP standard field 302-C2.
303person code300;3FREE TEXTCode assigned to a specific person within a family. NCPDP standard field 303-C3.
304date of birth300;4FREE TEXTDate of birth of patient. NCPDP standard field 304-C4.
305patient gender code300;5FREE TEXTOne of three codes to indicate the gender of the patient. 0 = Not Specific 1 = Male 2 = Female NCPDP standard field 305-C5.
306patient relationship code300;6FREE TEXTCode indicating relationship of patient to cardholder. NCPDP standard field 306-C6.
307place of service300;7FREE TEXTCode identifying the location of the patient when receiving pharmacy services. NCPDP standard field 307-C7. (was PATIENT LOCATION) Ø=Not Specified 1=Home 2=Inter-Care 3=Nursing Home 4=Long Term/Extended Care 5=Rest Home 6=Boarding Home 7=Skilled Care Facility 8=Sub-Acute Care Facility 9=Acute Care Facility 1Ø=Outpatient 11=Hospice
309eligibility clarification code300;9FREE TEXTCode indicating that the pharmacy is clarifying eligibility based on receiving a denial. NCPDP standard field 309-C9.
310patient first name300;10FREE TEXTFirst name of patient receiving the prescription. NCPDP standard field 310-CA.
311patient last name300;11FREE TEXTLast Name of patient receiving the prescription. NCPDP standard field 311-CB.
312cardholder first name300;12FREE TEXTFirst name of the Cardholder/Subscriber. NCPDP standard field 312-CC.
313cardholder last name300;13FREE TEXTLast name of the cardholder/subscriber. NCPDP standard field 313-CD.
314home plan300;14FREE TEXTCode identifying the Blue Cross or Blue Shield plan ID which indicates where the member's coverage has been designated. Usually where the member lives or purchased their coverage. NCPDP standard field 314-CE.
322patient street address321;2FREE TEXTFree-form text for Patient address information. NCPDP standard field 322-CM.
323patient city address321;3FREE TEXTFree-form text for city name. NCPDP standard field 323-CN.
324patient state prov address321;4FREE TEXTStandard State/Province Code as defined by appropriate government agency. NCPDP standard field 324-CO.
325patient zip postal zone321;5FREE TEXTCode defining international postal zone excluding punctuation and blanks (zip code for US). NCPDP standard field 325-CP.
326patient phone number321;6FREE TEXTTen-digit phone number of patient. NCPDP standard field 326-CQ.
331patient id qualifier330;1FREE TEXTCode qualifying the 'Patient ID'(332-CY). NCPDP standard field 331-CX. Blank=Not Specified Ø1=Social Security Number Ø2=Driver's License Number Ø3=U.S. Military ID 99=Other
332patient id330;2FREE TEXTID assigned to the patient. NCPDP standard field 332-CY.
333employer id330;3FREE TEXTID assigned to employer. NCPDP standard field 333-CZ.
334smoker indicator330;4FREE TEXTCode indicating the patient as a smoker or non-smoker. NCPDP standard field 334-1C. Blank=Not Specified 1=Non-Smoker 2=Smoker
335pregnancy indicator330;5FREE TEXTCode indicating the patient as pregnant or non-pregnant. NCPDP standard field 335-2C. Blank=Not Specified 1=Not pregnant 2=Pregnant
336facility id330;6FREE TEXTID assigned to the patient's clinic/host party. NCPDP standard field 336-8C.
350patient e-mail address340;10FREE TEXTThis is used to store NCPDP field 350-HN (Patient E-Mail Address), which is defined as "The E-Mail address of the patient (member)."
356other payer cardholder id350;6FREE TEXTThis is used to store NCPDP field 356-NU (Other Payer Cardholder ID), which is defined as "Cardholder ID for this member that is associated with the Payer noted."
359medigap id350;9FREE TEXTThis is used to store NCPDP field 359-2A (Medigap ID), which is defined as "Patient's ID assigned by the Medigap Insurer."
360medicaid indicator350;10FREE TEXTThis is used to store NCPDP field 360-2B (Medicaid Indicator), which is defined as "Two character State Postal Code indicating the state where Medicaid coverage exists."
361provider accept assgnmt indctr360;1FREE TEXTThis is used to store NCPDP field 361-2D (Provider Accept Assignment Indicator), which is defined as "Code indicating whether the provider accepts assignment."
384patient residence380;4FREE TEXTThis is used to store NCPDP field 384-4X (Patient Residence), which is defined as "Code identifying the patient's place of residence."
400transactions400;0MULTIPLE9002313.0201This subfile has the transactions that are included in this request. There is only one for reversals and eligibility verification request and up to four for a billing request.
401date of service401;1FREE TEXTAFDate prescription was dispensed. NCPDP standard field 401-D1.
524plan id520;4FREE TEXTAssigned by the processor to identify a set of parameters, benefit, or coverage criteria used to adjudicate a claim. NCPDP standard field 524-FO.
Specify if the claim has been closed (no longer needed for followup) or not.
902date closed900;2DATE-TIMEAGThis is automatically populated with the date a claim was closed.
903closed by900;3POINTER200This is automatically populated with the user who closed the claim.
904closed reason900;4POINTER356.8The ECME-supported non-billable reason entered by the user or defaulted by the system.
905drop to paper900;5SET OF CODESD:DROP TO PAPER
If close reason is 90 DAY RX FILL NOT COVERED or NOT A CONTRACTED PROVIDER then user will be prompted: Treat as (N)on-Billable Episode or (D)rop Bill to Paper? the answer is stored in this field and sent to IB
906date reopened900;6DATE-TIMEDate and time when the claim was re-opened.
907reopened by900;7POINTER200The system user who re-opened the claim.
908reopened comment900;8FREE TEXTUser comments for the re-opening of the claim.
990other payer bin number980;10FREE TEXTThis is used to store NCPDP field 990-MG (Other Payer BIN Number), which is defined as "The secondary, tertiary, etc. card issuer or bank ID number used for network routing."
991other payer processor cntrl no990;1FREE TEXTThis is used to store NCPDP field 991-MH (Other Payer Processor Control Number), which is defined as "A number that uniquely identifies the secondary, tertiary, etc. payer to the processor."
992other payer group id990;2FREE TEXTThis is used to store NCPDP field 992-MJ (Other Payer Group ID), which is defined as "ID assigned to the cardholder group or employer group by the secondary, tertiary, etc. payer."
997cms part d defined qlfd faclty990;7FREE TEXTThis is used to store NCPDP field 997-G2 (CMS Part D Defined Qualified Facility), which is defined as "Indicates that the patient resides in a facility that qualifies for the CMS Part D benefit."
1022patient id state/provinceA20;2FREE TEXTNCPDP Standard field A22-YR The postal state code abbreviation that is used in conjunction with the Patient ID Qualifier and the Patient ID fields to identify what state the identification is from.
1043patient country codeA40;3FREE TEXTNCPDP Standard field A43-1K The country of the patient's permanent residence.
1045veterinary use indicatorA40;5FREE TEXTNCPDP Standard field A45-1R To indicate that the prescription was dispensed for use on something other than human.
9999raw data sentM;0WORD-PROCESSINGAn exact copy of the record sent via the communications protocol.

Referenced by 4 types

  1. BPS RESPONSES (9002313.03) -- bps claim
  2. BPS CERTIFICATION (9002313.31) -- claim
  3. BPS LOG OF TRANSACTIONS (9002313.57) -- claim, reversal claim
  4. BPS TRANSACTION (9002313.59) -- claim, reversal claim