| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | plan id | 0;1 | POINTER | 355.3 | B | Insurance plan ID sent from the IB API |
| 902.02 | b1 payer sheet | 0;2 | POINTER | 9002313.92 | This the payer sheet used to submit billing request for this particular insurer. Billing request transmissions will be formatted per the specifications in this payer sheet. | |
| 902.03 | bin | 1;1 | FREE TEXT | Card Issuer ID or Bank ID Number used for network routing. | ||
| 902.04 | pcn | 1;2 | FREE TEXT | Processor control number assigned for the payer sheet. | ||
| 902.05 | group id | 1;3 | FREE TEXT | ID assigned to the cardholder group or employer group. | ||
| 902.06 | cardholder id | 1;4 | FREE TEXT | Insured person | ||
| 902.07 | patient relationship code | 1;5 | SET OF CODES | 0:NOT SPECIFIED 1:CARDHOLDER (SELF) 2:SPOUSE 3:CHILD 4:OTHER | This stores the relationship of the patient to insurance subscriber and will be used to populate the NCPDP 306-C6 (PATIENT RELATIONSHIP CODE) field. | |
| 902.08 | cardholder first name | 1;6 | FREE TEXT | First name of the Cardholder/Subscriber. | ||
| 902.09 | cardholder last name | 1;7 | FREE TEXT | Last name of the Cardholder/Subscriber. | ||
| 902.1 | person code | 1;10 | FREE TEXT | This is the Person Code that will be placed in NCPDP field 303-C3 (Person Code). This value is specified by the third-party payer and is found on the patient's insurance card. | ||
| 902.11 | home plan state | 1;8 | FREE TEXT | Usually the state where the member lives or purchased their coverage. | ||
| 902.12 | dispensing fee submitted | 2;1 | NUMERIC | Fee amount submitted for the cost associated with dispensing this prescription. | ||
| 902.13 | basis of cost determination | 2;2 | FREE TEXT | Code indicating the method by which 'Ingredient Cost Submitted' was calculated. | ||
| 902.14 | usual customary charge | 2;3 | NUMERIC | Amount charged cash customers for the prescription exclusive of sales tax or other amounts claimed. | ||
| 902.15 | gross amount due | 2;4 | NUMERIC | Total price claimed from all sources. For prescription claim request, field represents a sum of 'Ingredient Cost Submitted' (4Ø9-D9), 'Dispensing Fee Submitted' (412-DC), 'Flat Sales Tax Amount Submitted'(481-HA), 'Percentage Sales Tax Amount Submitted' (482-GE), 'Incentive Amount Submitted' (438-E3), 'Other Amount Claimed' (48Ø-H9). For service claim request, field represents a sum of 'Professional Services Fee Submitted' (477-BE), 'Flat Sales Tax Amount Submitted'(481-HA), 'Percentage Sales Tax Amount Submitted'(482-GE), 'Other Amount Claimed' (48Ø-H9) | ||
| 902.16 | administrative fee | 2;5 | NUMERIC | Fee charged for any costs related to preparing the prescription. | ||
| 902.17 | va fill number | 2;6 | NUMERIC | Which fill/refill this transaction is for. | ||
| 902.18 | software vendor cert id | 2;7 | FREE TEXT | Certification number assigned by payer to the sending entity, allowing claims to be sent. | ||
| 902.19 | b2 payer sheet | 0;3 | POINTER | 9002313.92 | This is the reversal payer sheet associated with the payer. | |
| 902.2 | ingredient cost | 2;10 | NUMERIC | This is the INGREDIENT COST that will be placed in the NCPDP field 409-D9 (INGREDIENT COST SUBMITTED) field of the NCPDP submission. | ||
| 902.21 | b3 payer sheet | 0;4 | POINTER | 9002313.92 | This is the payer sheet to be used for a rebill request for this insurer. Rebill transmission will be formatted per the specifications in this payer sheet. | |
| 902.22 | certify mode | 0;5 | SET OF CODES | 0:CERTIFY MODE ON 1:CERTIFY MODE OFF | This is to specify if the claim was used for certification. | |
| 902.23 | certification | 0;6 | POINTER | 9002313.31 | This field is used during certification testing, and contains the pointer to the Certification file 9002313.31. | |
| 902.24 | insurance name | 0;7 | FREE TEXT | This field is the Plan Name for the insurance being filed. | ||
| 902.25 | group name | 3;1 | FREE TEXT | This is the Group Name for the Group Insurance file | ||
| 902.26 | insurance co phone | 3;2 | FREE TEXT | This is the Claims (RX) phone number from the Insurance Company file | ||
| 902.27 | pharmacy plan id | 3;3 | FREE TEXT | This is a ID of the Plan file | ||
| 902.28 | eligibility | 3;4 | SET OF CODES | V:VETERAN T:TRICARE C:CHAMPVA | The insurance eligibility type of the claim. | |
| 902.29 | rate type | 0;8 | POINTER | 399.3 | The Rate Type selected by the user for billing. | |
| 902.3 | primary payer bill | 2;8 | POINTER | 399 | Primary bill which should be used to create the secondary bill. This field is used for secondary billing only. | |
| 902.31 | prior payment | 2;9 | NUMERIC | Dollar amount paid by the Primary insurer. This field is used for secondary billing only. | ||
| 902.32 | plan cob | 3;6 | SET OF CODES | 1:PRIMARY 2:SECONDARY 3:TERTIARY | The Coordination of Benefits value as it is stored in (#.2) COB field of the (#.3121) Insurance Type multiple of the Patient file (#2). | |
| 902.33 | insurance company | 3;5 | POINTER | 36 | This is the INSURANCE COMPANY from file #36. | |
| 902.34 | e1 payer sheet | 0;9 | POINTER | 9002313.92 | This is the payer sheet to be used for eligibility verification requests for this insurer. Eligibility verification transmissions will be formatted per the specifications in this payer sheet. | |
| 902.35 | policy number | 0;12 | NUMERIC | This is the policy number assigned for this particular patient and insurer. | ||
| 902.36 | maximum ncpdp transactions | 1;9 | NUMERIC | This is the maximum number of transactions that can be bundled in a transmission. It is specified by the NCPDP processor. |
Error: Invalid Global File Type: 9002313.57902