| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | transaction number(+) | 0;1 | NUMERIC | B | The transaction number of the claim | |
| .02 | type | 0;2 | SET OF CODES | R:REVERSAL RS:RESUBMIT WITH REVERSAL S:SUBMIT E:ELIGIBILITY | This is the type of request that is being overridden. | |
| .03 | submission response | 0;3 | SET OF CODES | D:DUPLICATE P:PAID R:REJECTED S:STRANDED | The payer response for claims submissions (B1 transactions) - 'P' for Payable or 'R' for Rejected. This will be used for the 112 (Transaction Response Status) and 501 (Response Status) fields or BPS Responses. | |
| .04 | paid amount | 0;4 | NUMERIC | This is the override for the 509 (Total Amount Paid) field of BPS Responses | ||
| .05 | reversal response | 0;5 | SET OF CODES | A:ACCEPTED D:DUPLICATE R:REJECTED S:STRANDED | The payer response for claims reversals (B2 transactions) - 'A' for Accepted or 'R' for Rejected. This will be used for the 112 (Transaction Response Status) and 501 (Response Status) fields or BPS Responses. | |
| .06 | copay amount | 0;6 | NUMERIC | This is an override copay amount returned by a payer to be sent to Integrated Billing for copay creation. | ||
| .07 | delay | 0;7 | NUMERIC | Processing delay in minutes. | ||
| .08 | eligibility response | 0;8 | SET OF CODES | A:ACCEPTED R:REJECTED S:STRANDED | This is the override value that will be used for the payer response for eligibility verification requests. The value will be used to populate the 112 (Transaction Response Status) and 501 (Response Status) fields of BPS Responses. | |
| .09 | next available fill date | 0;9 | DATE-TIME | This is the override value that will be used for the payer response for billing requests. The value will be used to populate the NEXT AVAILABLE FILL DATE (#2004) field of RESPONSES (#9002313.0301) subfile of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code B04-BT. | ||
| .1 | adjudicated payment type | 0;10 | SET OF CODES | 1:MEDICAID 2:MEDICARE 3:COMMERCIAL 4:WORKERS COMPENSATION 5:DISCOUNT PROGRAM 6:COUPON REIMBURSEMENT 7:VOUCHER 8:MILITARY/VA 99:OTHER | This is the override value that will be used for the payer response for billing requests. The value will be used to populate the ADJUDICATED PAYMENT TYPE (#1028) field of RESPONSES (#9002313.0301) subfile of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code A28-ZR. | |
| 1 | reject codes | 1;0 | MULTIPLE | 9002313.321 | Multiple for reject code overrides, which will be stored in the 511 (Reject Code multiple) fields of BPS Responses |
Not Referenced