| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | name(+) | 0;1 | FREE TEXT | B | This is the name used to distinguish the BPS Pharmacy. | |
| .02 | ncpdp # | 0;2 | FREE TEXT | The NCPDP # is sent as part of the electronic claim header. | ||
| .03 | default dea #(+) | 0;3 | FREE TEXT | Many insurances require the prescriber's DEA number as part of the claim. If your pharmacy has a DEA # that may be used in case a prescriber doesn't have this DEA # on file with you, enter that default DEA # here. | ||
| .04 | last registered status | 0;4 | SET OF CODES | 1:ACTIVE 0:INACTIVE | This field is set by the software in the background when registration messages are sent to Austin. If the STATUS is Inactive and the last registered status is also Inactive then this pharmacy will not be registered again as Inactive. | |
| .09 | auto-reverse parameter | 0;9 | NUMERIC | ECME shall use the following AUTO-REVERSE site parameter when determining whether non-released prescription claims (that have a PAYABLE payer returned response) are to be automatically REVERSED. The AUTO-REVERSE site parameter is set for the number of days that ECME will wait before the claim is automatically REVERSED. The user is allowed to enter a number as follows: 0 - ECME Auto-Reverse is turned off, 1 to 30 - ECME will wait the entered number of days before REVERSING the non-released Rx with a PAYABLE payer returned response. | ||
| .1 | status(+) | 0;10 | SET OF CODES | 1:ACTIVE 0:INACTIVE | Indicates whether a BPS Pharmacy is active or inactive. If active, claims will be processed through ECME. | |
| 1 | cmop switch(+) | 0;8 | SET OF CODES | 0:CMOP OFF 1:CMOP ON | Indicates whether ECME shall process CMOP claims. If ON, CMOP claims will be processed. If OFF, CMOP claims will not be processed. | |
| 41.01 | npi | NPI;1 | FREE TEXT | National Provider ID. This is a unique ID assigned to providers by CMS. It is used as the second piece of the Claim ID field (.01) of BPS CLAIMS file (#9002313.02) and is sent as part of the electronic claim header. | ||
| 41.02 | date/time of last npi change | NPI;2 | DATE-TIME | This is the date and time of the last change to the NPI value. | ||
| 102.03 | site city(+) | ADDR;3 | FREE TEXT | Enter City | ||
| 120.01 | site address 1(+) | ADDR;1 | FREE TEXT | The site's street address. | ||
| 120.02 | site address 2 | ADDR;2 | FREE TEXT | Site's address line 2. | ||
| 120.03 | site address name(+) | ADDR;8 | FREE TEXT | Site's Business name. | ||
| 120.04 | site state(+) | ADDR;4 | POINTER | 5 | This is the state in which the site is located. | |
| 120.05 | site zip code(+) | ADDR;5 | FREE TEXT | This is the zip code for the ePharmacy billing site. | ||
| 120.06 | site phone | ADDR;6 | FREE TEXT | For NCPDP claim forms. | ||
| 120.07 | site fax | ADDR;7 | FREE TEXT | For NCPDP claim forms. | ||
| 130.01 | remittance address name(+) | REMIT;1 | FREE TEXT | Pharmacy Business Name | ||
| 130.02 | remit address 1(+) | REMIT;2 | FREE TEXT | Street Address (Line 1) for the Remittance Address. | ||
| 130.03 | remit address 2 | REMIT;3 | FREE TEXT | Street Address (Line 2) for the Remittance Address. | ||
| 130.04 | remit dwelling number | REMIT;4 | FREE TEXT | Enter the dwelling number for the claim remittance address. | ||
| 130.07 | remit state(+) | REMIT;7 | POINTER | 5 | Enter the state for the claim remittance address. | |
| 130.08 | remit zip(+) | REMIT;8 | FREE TEXT | Enter the zip for the claim remittance address. | ||
| 130.5 | remit other designation | REMIT;5 | FREE TEXT | Enter the other designation for the claim remittance address. | ||
| 130.6 | remit city(+) | REMIT;6 | FREE TEXT | Enter the city for the claim remittance address. | ||
| 1830.01 | contact names | REP;1 | FREE TEXT | You may enter more than one name, separated by "/". Put corresponding phone numbers separated by "/" in the phone number field. A random name-phone combination will appear on each bill and that way the calls get distributed evenly. | ||
| 1830.02 | contact phones | REP;2 | FREE TEXT | (See CONTACT NAMES description for details about "/"-separated list.) | ||
| 1900.01 | va contact(+) | REP;3 | POINTER | 200 | Pointer to the New Person file for the VA contact person information. | |
| 1900.02 | va alternate contact(+) | REP;4 | POINTER | 200 | This is the alternate site contact name to be contacted if site setup problems are identified. | |
| 1900.03 | va lead pharmacist(+) | REP;5 | POINTER | 200 | Pointer to the New Person file for the lead Pharmacists. | |
| 1900.04 | va lead pharmacist license # | REP1;1 | FREE TEXT | The lead pharmacist license number will be used as a default on ePharmacy claims. | ||
| 13800 | outpatient site | OPSITE;0 | MULTIPLE | 9002313.5601 |