1. EPMO Open Source Coordination Office Redaction File Detail Report

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1.1 Files compared

#	Location	File	Last Modified
1	BPS_1.0_21_Build_8.zip	BPS_1_21_TEST_V8.kid	Fri Aug 4 15:04:12 2017 UTC
2	BPS_1.0_21_Build_8.zip	BPS_1_21_TEST_V8.kid	Sat Aug 5 13:23:33 2017 UTC

1.2 Comparison summary

Description	Between Files 1 and 2
Description	Text Blocks	Lines
Unchanged	1	25880
Changed	0	0
Inserted	1	12
Removed	0	0

1.3 Comparison options

Whitespace
Character case	Differences in character case are significant
Line endings	Differences in line endings (`CR` and `LF` characters) are ignored
CR/LF characters	Not shown in the comparison detail

1.4 Active regular expressions

No regular expressions were active.

1.5 Comparison detail

1	BPS121 T EST v8
2	Extracted from mail message
3	KIDS:B PS1.021^
4
5	INSTALL NAME
6	BPS1.021
7	"BLD",1045 8,0)
8	BPS1.021 ^E CLAIMS MGMT ENGIN E^0^317060 5^y
9	"BLD",1045 8,1,0)
10	^^1^1^3170 315^^^^
11	"BLD",1045 8,1,1,0)
12	MCCF EDI T AS ePharma cy Iterati on 1
13	"BLD",1045 8,4,0)
14	^9.64PA^90 02313.02^4
15	"BLD",1045 8,4,900231 3.02,0)
16	9002313.02
17	"BLD",1045 8,4,900231 3.02,2,0)
18	^9.641^900 2313.0201^ 1
19	"BLD",1045 8,4,900231 3.02,2,900 2313.0201, 0)
20	TRANSACTIO NS (sub-f ile)
21	"BLD",1045 8,4,900231 3.02,2,900 2313.0201, 1,0)
22	^9.6411^21 02^4
23	"BLD",1045 8,4,900231 3.02,2,900 2313.0201, 1,2096,0)
24	PROVIDER F IRST NAME
25	"BLD",1045 8,4,900231 3.02,2,900 2313.0201, 1,2097,0)
26	PROVIDER L AST NAME
27	"BLD",1045 8,4,900231 3.02,2,900 2313.0201, 1,2101,0)
28	ORIG MANUF ACTURER PR ODUCT ID
29	"BLD",1045 8,4,900231 3.02,2,900 2313.0201, 1,2102,0)
30	ORIG MANUF ACTURER PR OD ID QUAL
31	"BLD",1045 8,4,900231 3.02,222)
32	y^n^p^^^^n ^^n
33	"BLD",1045 8,4,900231 3.02,224)
34
35	"BLD",1045 8,4,900231 3.25,0)
36	9002313.25
37	"BLD",1045 8,4,900231 3.25,222)
38	y^n^f^^n^^ y^o^n
39	"BLD",1045 8,4,900231 3.91,0)
40	9002313.91
41	"BLD",1045 8,4,900231 3.91,222)
42	y^n^f^^n^^ y^o^n
43	"BLD",1045 8,4,900231 3.93,0)
44	9002313.93
45	"BLD",1045 8,4,900231 3.93,222)
46	y^n^f^^n^^ y^o^n
47	"BLD",1045 8,4,"APDD" ,9002313.0 2,9002313. 0201)
48
49	"BLD",1045 8,4,"APDD" ,9002313.0 2,9002313. 0201,2096)
50
51	"BLD",1045 8,4,"APDD" ,9002313.0 2,9002313. 0201,2097)
52
53	"BLD",1045 8,4,"APDD" ,9002313.0 2,9002313. 0201,2101)
54
55	"BLD",1045 8,4,"APDD" ,9002313.0 2,9002313. 0201,2102)
56
57	"BLD",1045 8,4,"B",90 02313.02,9 002313.02)
58
59	"BLD",1045 8,4,"B",90 02313.25,9 002313.25)
60
61	"BLD",1045 8,4,"B",90 02313.91,9 002313.91)
62
63	"BLD",1045 8,4,"B",90 02313.93,9 002313.93)
64
65	"BLD",1045 8,6.3)
66	28
67	"BLD",1045 8,"ABPKG")
68	n
69	"BLD",1045 8,"INI")
70	EN^BPS21PR E
71	"BLD",1045 8,"INID")
72	^^n
73	"BLD",1045 8,"KRN",0)
74	^9.67PA^77 9.2^20
75	"BLD",1045 8,"KRN",.4 ,0)
76	.4
77	"BLD",1045 8,"KRN",.4 ,"NM",0)
78	^9.68A^^
79	"BLD",1045 8,"KRN",.4 01,0)
80	.401
81	"BLD",1045 8,"KRN",.4 02,0)
82	.402
83	"BLD",1045 8,"KRN",.4 03,0)
84	.403
85	"BLD",1045 8,"KRN",.5 ,0)
86	.5
87	"BLD",1045 8,"KRN",.8 4,0)
88	.84
89	"BLD",1045 8,"KRN",3. 6,0)
90	3.6
91	"BLD",1045 8,"KRN",3. 8,0)
92	3.8
93	"BLD",1045 8,"KRN",9. 2,0)
94	9.2
95	"BLD",1045 8,"KRN",9. 8,0)
96	9.8
97	"BLD",1045 8,"KRN",9. 8,"NM",0)
98	^9.68A^3^3
99	"BLD",1045 8,"KRN",9. 8,"NM",1,0 )
100	BPSSCRU4^^ 0^B7000244 2
101	"BLD",1045 8,"KRN",9. 8,"NM",2,0 )
102	BPSRES^^0^ B205023095
103	"BLD",1045 8,"KRN",9. 8,"NM",3,0 )
104	BPSSCRU3^^ 0^B4446107 3
105	"BLD",1045 8,"KRN",9. 8,"NM","B" ,"BPSRES", 2)
106
107	"BLD",1045 8,"KRN",9. 8,"NM","B" ,"BPSSCRU3 ",3)
108
109	"BLD",1045 8,"KRN",9. 8,"NM","B" ,"BPSSCRU4 ",1)
110
111	"BLD",1045 8,"KRN",19 ,0)
112	19
113	"BLD",1045 8,"KRN",19 .1,0)
114	19.1
115	"BLD",1045 8,"KRN",10 1,0)
116	101
117	"BLD",1045 8,"KRN",10 1,"NM",0)
118	^9.68A^^0
119	"BLD",1045 8,"KRN",40 9.61,0)
120	409.61
121	"BLD",1045 8,"KRN",40 9.61,"NM", 0)
122	^9.68A^^0
123	"BLD",1045 8,"KRN",77 1,0)
124	771
125	"BLD",1045 8,"KRN",77 9.2,0)
126	779.2
127	"BLD",1045 8,"KRN",77 9.2,"NM",0 )
128	^9.68A^^
129	"BLD",1045 8,"KRN",87 0,0)
130	870
131	"BLD",1045 8,"KRN",89 89.51,0)
132	8989.51
133	"BLD",1045 8,"KRN",89 89.52,0)
134	8989.52
135	"BLD",1045 8,"KRN",89 94,0)
136	8994
137	"BLD",1045 8,"KRN","B ",.4,.4)
138
139	"BLD",1045 8,"KRN","B ",.401,.40 1)
140
141	"BLD",1045 8,"KRN","B ",.402,.40 2)
142
143	"BLD",1045 8,"KRN","B ",.403,.40 3)
144
145	"BLD",1045 8,"KRN","B ",.5,.5)
146
147	"BLD",1045 8,"KRN","B ",.84,.84)
148
149	"BLD",1045 8,"KRN","B ",3.6,3.6)
150
151	"BLD",1045 8,"KRN","B ",3.8,3.8)
152
153	"BLD",1045 8,"KRN","B ",9.2,9.2)
154
155	"BLD",1045 8,"KRN","B ",9.8,9.8)
156
157	"BLD",1045 8,"KRN","B ",19,19)
158
159	"BLD",1045 8,"KRN","B ",19.1,19. 1)
160
161	"BLD",1045 8,"KRN","B ",101,101)
162
163	"BLD",1045 8,"KRN","B ",409.61,4 09.61)
164
165	"BLD",1045 8,"KRN","B ",771,771)
166
167	"BLD",1045 8,"KRN","B ",779.2,77 9.2)
168
169	"BLD",1045 8,"KRN","B ",870,870)
170
171	"BLD",1045 8,"KRN","B ",8989.51, 8989.51)
172
173	"BLD",1045 8,"KRN","B ",8989.52, 8989.52)
174
175	"BLD",1045 8,"KRN","B ",8994,899 4)
176
177	"BLD",1045 8,"QUES",0 )
178	^9.62^^
179	"BLD",1045 8,"REQB",0 )
180	^9.611^3^1
181	"BLD",1045 8,"REQB",3 ,0)
182	BPS1.020 ^1
183	"BLD",1045 8,"REQB"," B","BPS1. 020",3)
184
185	"DATA",900 2313.25,1, 0)
186	0^ZZ DO NO T USE - NO T SPECIFIE D, DEFAULT
187	"DATA",900 2313.25,2, 0)
188	1^NO OVERR IDE
189	"DATA",900 2313.25,3, 0)
190	2^OTHER OV ERRIDE
191	"DATA",900 2313.25,4, 0)
192	3^VACATION SUPPLY
193	"DATA",900 2313.25,5, 0)
194	4^LOST PRE SCRIPTION
195	"DATA",900 2313.25,6, 0)
196	5^THERAPY CHANGE
197	"DATA",900 2313.25,7, 0)
198	6^STARTER DOSE
199	"DATA",900 2313.25,8, 0)
200	7^MEDICALL Y NECESSAR Y
201	"DATA",900 2313.25,9, 0)
202	8^PROCESS COMPOUND F OR APPROVE D INGREDIE NTS
203	"DATA",900 2313.25,10 ,0)
204	9^ENCOUNTE RS
205	"DATA",900 2313.25,11 ,0)
206	99^OTHER
207	"DATA",900 2313.25,12 ,0)
208	10^MEETS P LAN LIMITA TIONS
209	"DATA",900 2313.25,13 ,0)
210	11^CERTIFI CATION ON FILE
211	"DATA",900 2313.25,14 ,0)
212	12^DME REP LACEMENT I NDICATOR
213	"DATA",900 2313.25,15 ,0)
214	13^PAYER-R ECOGNIZED EMERGENCY/ DISASTER A SSISTANCE REQUEST
215	"DATA",900 2313.25,16 ,0)
216	14^LONG TE RM CARE LE AVE OF ABS ENCE
217	"DATA",900 2313.25,17 ,0)
218	15^LONG TE RM CARE RE PLACEMENT MEDICATION
219	"DATA",900 2313.25,18 ,0)
220	16^LONG TE RM CARE EM ERGENCY BO X (KIT) OR AUTOMATED DISPENSIN G MACHINE
221	"DATA",900 2313.25,19 ,0)
222	17^LONG TE RM CARE EM ERGENCY SU PPLY REMAI NDER
223	"DATA",900 2313.25,20 ,0)
224	18^LONG TE RM CARE PA TIENT ADMI T/READMIT INDICATOR
225	"DATA",900 2313.25,21 ,0)
226	19^SPLIT B ILLING
227	"DATA",900 2313.25,22 ,0)
228	21^LTC DIS PENSING: 1 4 DAYS OR LESS NOT A PPLICABLE
229	"DATA",900 2313.25,23 ,0)
230	22^LTC DIS PENSING: 7 DAYS
231	"DATA",900 2313.25,24 ,0)
232	23^LTC DIS PENSING: 4 DAYS
233	"DATA",900 2313.25,25 ,0)
234	24^LTC DIS PENSING: 3 DAYS
235	"DATA",900 2313.25,26 ,0)
236	25^LTC DIS PENSING: 2 DAYS
237	"DATA",900 2313.25,27 ,0)
238	26^LTC DIS PENSING: 1 DAY
239	"DATA",900 2313.25,28 ,0)
240	27^LTC DIS PENSING: 4 -3 DAYS
241	"DATA",900 2313.25,29 ,0)
242	28^LTC DIS PENSING: 2 -2-3 DAYS
243	"DATA",900 2313.25,30 ,0)
244	29^LTC DIS PENSING: D AILY AND 3 -DAY WEEKE ND
245	"DATA",900 2313.25,31 ,0)
246	30^LTC DIS PENSING: P ER SHIFT D ISPENSING
247	"DATA",900 2313.25,32 ,0)
248	31^LTC DIS PENSING: P ER MED PAS S DISPENSI NG
249	"DATA",900 2313.25,33 ,0)
250	32^LTC DIS PENSING: P RN ON DEMA ND
251	"DATA",900 2313.25,34 ,0)
252	33^LTC DIS PENSING: 7 DAY OR LE SS CYCLE N OT OTHERWI SE REPRESE NTED
253	"DATA",900 2313.25,35 ,0)
254	34^LTC DIS PENSING: 1 4 DAYS DIS PENSING
255	"DATA",900 2313.25,36 ,0)
256	35^LTC DIS PENSING: 8 -14 DAY DI SPENSING M ETHOD NOT LISTED
257	"DATA",900 2313.25,37 ,0)
258	36^LTC DIS PENSING: D ISPENSED O UTSIDE SHO RT CYCLE
259	"DATA",900 2313.25,38 ,0)
260	20^SECTION 340B OF T HE PUBLIC HEALTH ACT OF 1992
261	"DATA",900 2313.25,39 ,0)
262	42^PRESCRI BER ID VAL ID - PRESC RIBING REQ UIREMENTS VALIDATED
263	"DATA",900 2313.25,40 ,0)
264	43^PRESCRI BER'S DEA ACTIVE W/D EA AUTHORI ZED PRESCR IPTIVE RIG HT
265	"DATA",900 2313.25,41 ,0)
266	44^ZZ DO N OT USE - A SSOCIATED PRESCRIBER DEA RECEN TLY LICENS ED OR RE-A CTIVATED
267	"DATA",900 2313.25,42 ,0)
268	45^PRESCRI BER'S DEA VALID HOSP DEA W/SUF FIX-HAS PR ESCRIPTIVE AUTH DRUG DEA SCHED ULE
269	"DATA",900 2313.25,43 ,0)
270	46^PRESCRI BER'S DEA HAS PRESCR IPTIVE AUT HORITY FOR THIS DRUG DEA SCHED ULE
271	"DATA",900 2313.25,44 ,0)
272	47^SHORTEN ED DAYS SU PPLY FILL
273	"DATA",900 2313.25,45 ,0)
274	48^FILL SU BSEQUENT T O A SHORTE NED DAYS S UPPLY FILL
275	"DATA",900 2313.25,46 ,0)
276	49^PRESCRI BER DOES N OT CURRENT LY HAVE AN ACTIVE TY PE 1 NPI
277	"DATA",900 2313.25,47 ,0)
278	52^PRESCRI BER'S STAT E LICENSE WITH PRESC RIPTIVE AU THORITY HA S BEEN VAL IDATED
279	"DATA",900 2313.25,48 ,0)
280	53^PRESCRI BER NPI AC TIVE & VAL ID-MEDICAR E ENROLLME NT & RX AU THORITY VA LIDATED
281	"DATA",900 2313.25,49 ,0)
282	54^CMS OTH ER AUTHORI ZED PRESCR IBER: PROV IDER W/RX AUTHORITY, MEDICARE INELIGIBLE
283	"DATA",900 2313.91,1, 0)
284	101^^BIN N UMBER^N^^^ ^6^N
285	"DATA",900 2313.91,1, 5)
286	A1^6
287	"DATA",900 2313.91,1, 10,0)
288	^9002313.9 101^1^1^30 61023
289	"DATA",900 2313.91,1, 10,1,0)
290	S BPS("X") =$G(BPS("N CPDP","BIN Number"))
291	"DATA",900 2313.91,1, 20,0)
292	^9002313.9 102^1^1^31 01101
293	"DATA",900 2313.91,1, 20,1,0)
294	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),6)
295	"DATA",900 2313.91,1, 25,0)
296	^9002313.9 104^1^1^30 40130^^^^
297	"DATA",900 2313.91,1, 25,1,0)
298	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),6)
299	"DATA",900 2313.91,1, 30,0)
300	^9002313.9 103^1^1^30 40130^^^^
301	"DATA",900 2313.91,1, 30,1,0)
302	S $P(^BPSC (BPS(90023 13.02),100 ),U,1)=BPS ("X")
303	"DATA",900 2313.91,2, 0)
304	102^^VERSI ON/RELEASE NUMBER^A/ N^^^^2^A/N
305	"DATA",900 2313.91,2, 5)
306	A2^2
307	"DATA",900 2313.91,2, 10,0)
308	^9002313.9 101^1^1^30 61023
309	"DATA",900 2313.91,2, 10,1,0)
310	S BPS("X") =$G(BPS("N CPDP","Ver sion"))
311	"DATA",900 2313.91,2, 20,0)
312	^9002313.9 102^1^1^31 01101
313	"DATA",900 2313.91,2, 20,1,0)
314	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
315	"DATA",900 2313.91,2, 25,0)
316	^9002313.9 104^1^1^30 40114^^^^
317	"DATA",900 2313.91,2, 25,1,0)
318	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
319	"DATA",900 2313.91,2, 30,0)
320	^9002313.9 103^1^1^30 40114^^^^
321	"DATA",900 2313.91,2, 30,1,0)
322	S $P(^BPSC (BPS(90023 13.02),100 ),U,2)=BPS ("X")
323	"DATA",900 2313.91,3, 0)
324	103^^TRANS ACTION COD E^N^^^^2^A /N
325	"DATA",900 2313.91,3, 5)
326	A3^2
327	"DATA",900 2313.91,3, 10,0)
328	^9002313.9 101^1^1^30 61023
329	"DATA",900 2313.91,3, 10,1,0)
330	S BPS("X") =$G(BPS("T ransaction Code"))
331	"DATA",900 2313.91,3, 20,0)
332	^9002313.9 102^1^1^31 01101
333	"DATA",900 2313.91,3, 20,1,0)
334	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
335	"DATA",900 2313.91,3, 25,0)
336	^9002313.9 104^1^1^30 40130^^^^
337	"DATA",900 2313.91,3, 25,1,0)
338	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
339	"DATA",900 2313.91,3, 30,0)
340	^9002313.9 103^1^1^30 40130^^^^
341	"DATA",900 2313.91,3, 30,1,0)
342	S $P(^BPSC (BPS(90023 13.02),100 ),U,3)=BPS ("X")
343	"DATA",900 2313.91,4, 0)
344	104^^PROCE SSOR CONTR OL NUMBER^ A/N^^^^10^ A/N
345	"DATA",900 2313.91,4, 5)
346	A4^10
347	"DATA",900 2313.91,4, 10,0)
348	^9002313.9 101^1^1^30 61023
349	"DATA",900 2313.91,4, 10,1,0)
350	S BPS("X") =$G(BPS("N CPDP","PCN "))
351	"DATA",900 2313.91,4, 20,0)
352	^9002313.9 102^1^1^31 01101
353	"DATA",900 2313.91,4, 20,1,0)
354	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0)
355	"DATA",900 2313.91,4, 25,0)
356	^9002313.9 104^1^1^30 40820^^^^
357	"DATA",900 2313.91,4, 25,1,0)
358	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0)
359	"DATA",900 2313.91,4, 30,0)
360	^9002313.9 103^1^1^30 40820^^^^
361	"DATA",900 2313.91,4, 30,1,0)
362	S $P(^BPSC (BPS(90023 13.02),100 ),U,4)=BPS ("X")
363	"DATA",900 2313.91,5, 0)
364	201^^SERVI CE PROVIDE R ID^A/N^^ ^^15^A/N
365	"DATA",900 2313.91,5, 5)
366	B1^12
367	"DATA",900 2313.91,5, 10,0)
368	^^1^1^3110 523^
369	"DATA",900 2313.91,5, 10,1,0)
370	S BPS("X") =$G(BPS("S ite","NPI" ))
371	"DATA",900 2313.91,5, 20,0)
372	^9002313.9 102^1^1^31 10523^
373	"DATA",900 2313.91,5, 20,1,0)
374	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
375	"DATA",900 2313.91,5, 25,0)
376	^^1^1^3110 523^
377	"DATA",900 2313.91,5, 25,1,0)
378	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
379	"DATA",900 2313.91,5, 30,0)
380	^^1^1^3110 523^
381	"DATA",900 2313.91,5, 30,1,0)
382	S $P(^BPSC (BPS(90023 13.02),200 ),U,1)=BPS ("X")
383	"DATA",900 2313.91,6, 0)
384	301^^GROUP ID^A/N^^^ ^15^A/N
385	"DATA",900 2313.91,6, 5)
386	C1^15
387	"DATA",900 2313.91,6, 10,0)
388	^9002313.9 101^1^1^31 01216^
389	"DATA",900 2313.91,6, 10,1,0)
390	S BPS("X") =$G(BPS("I nsurer","G roup #"))
391	"DATA",900 2313.91,6, 20,0)
392	^9002313.9 102^1^1^31 01101
393	"DATA",900 2313.91,6, 20,1,0)
394	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
395	"DATA",900 2313.91,6, 25,0)
396	^9002313.9 104^1^1^30 41021^^^^
397	"DATA",900 2313.91,6, 25,1,0)
398	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
399	"DATA",900 2313.91,6, 30,0)
400	^9002313.9 103^1^1^30 41021^^^^
401	"DATA",900 2313.91,6, 30,1,0)
402	S $P(^BPSC (BPS(90023 13.02),300 ),U,1)=BPS ("X")
403	"DATA",900 2313.91,7, 0)
404	302^^CARDH OLDER ID^A /N^^^^20^A /N
405	"DATA",900 2313.91,7, 5)
406	C2^20
407	"DATA",900 2313.91,7, 10,0)
408	^9002313.9 101^1^1^30 41021
409	"DATA",900 2313.91,7, 10,1,0)
410	S BPS("X") =$G(BPS("I nsurer","P olicy #"))
411	"DATA",900 2313.91,7, 20,0)
412	^9002313.9 102^1^1^31 01101
413	"DATA",900 2313.91,7, 20,1,0)
414	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
415	"DATA",900 2313.91,7, 25,0)
416	^9002313.9 104^1^1^30 61121^
417	"DATA",900 2313.91,7, 25,1,0)
418	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
419	"DATA",900 2313.91,7, 30,0)
420	^9002313.9 103^1^1^31 01004^^^
421	"DATA",900 2313.91,7, 30,1,0)
422	S $P(^BPSC (BPS(90023 13.02),300 ),U,2)=$TR (BPS("X"), " ","")
423	"DATA",900 2313.91,8, 0)
424	303^^PERSO N CODE^A/N ^^^^3^A/N
425	"DATA",900 2313.91,8, 5)
426	C3^3
427	"DATA",900 2313.91,8, 10,0)
428	^9002313.9 101^1^1^30 40114
429	"DATA",900 2313.91,8, 10,1,0)
430	S BPS("X") =$G(BPS("I nsurer","P erson Code "))
431	"DATA",900 2313.91,8, 20,0)
432	^9002313.9 102^1^1^31 01101
433	"DATA",900 2313.91,8, 20,1,0)
434	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
435	"DATA",900 2313.91,8, 25,0)
436	^9002313.9 104^1^1^30 40114^^^^
437	"DATA",900 2313.91,8, 25,1,0)
438	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
439	"DATA",900 2313.91,8, 30,0)
440	^9002313.9 103^1^1^30 40114^^^^
441	"DATA",900 2313.91,8, 30,1,0)
442	S $P(^BPSC (BPS(90023 13.02),300 ),U,3)=BPS ("X")
443	"DATA",900 2313.91,9, 0)
444	304^^DATE OF BIRTH^N ^^^^8^N
445	"DATA",900 2313.91,9, 5)
446	C4^8
447	"DATA",900 2313.91,9, 10,0)
448	^9002313.9 101^1^1^30 40820
449	"DATA",900 2313.91,9, 10,1,0)
450	S BPS("X") =$G(BPS("P atient","D OB"))
451	"DATA",900 2313.91,9, 20,0)
452	^9002313.9 102^1^1^31 01029^
453	"DATA",900 2313.91,9, 20,1,0)
454	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
455	"DATA",900 2313.91,9, 25,0)
456	^9002313.9 104^1^1^30 40820^^^^
457	"DATA",900 2313.91,9, 25,1,0)
458	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
459	"DATA",900 2313.91,9, 30,0)
460	^9002313.9 103^1^1^31 01004^
461	"DATA",900 2313.91,9, 30,1,0)
462	S $P(^BPSC (BPS(90023 13.02),300 ),U,4)=$G( BPS("X"))
463	"DATA",900 2313.91,10 ,0)
464	305^^PATIE NT GENDER CODE^N^^^^ 1^N
465	"DATA",900 2313.91,10 ,5)
466	C5^1
467	"DATA",900 2313.91,10 ,10,0)
468	^9002313.9 101^3^3^30 40114
469	"DATA",900 2313.91,10 ,10,1,0)
470	S BPS("X") =$G(BPS("P atient","S ex"))
471	"DATA",900 2313.91,10 ,10,2,0)
472	S BPS("X") =$E(BPS("X "),1,1)
473	"DATA",900 2313.91,10 ,10,3,0)
474	S BPS("X") =$S(BPS("X ")="M":"1" ,BPS("X")= "F":"2",1: "0")
475	"DATA",900 2313.91,10 ,20,0)
476	^9002313.9 102^1^1^31 01101
477	"DATA",900 2313.91,10 ,20,1,0)
478	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
479	"DATA",900 2313.91,10 ,25,0)
480	^9002313.9 104^1^1^30 40114^^
481	"DATA",900 2313.91,10 ,25,1,0)
482	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
483	"DATA",900 2313.91,10 ,30,0)
484	^9002313.9 103^1^1^30 40114^^^^
485	"DATA",900 2313.91,10 ,30,1,0)
486	S $P(^BPSC (BPS(90023 13.02),300 ),U,5)=BPS ("X")
487	"DATA",900 2313.91,11 ,0)
488	306^^PATIE NT RELATIO NSHIP CODE ^N^^^^1^N
489	"DATA",900 2313.91,11 ,5)
490	C6^1
491	"DATA",900 2313.91,11 ,10,0)
492	^9002313.9 101^1^1^30 40114
493	"DATA",900 2313.91,11 ,10,1,0)
494	S BPS("X") =$G(BPS("I nsurer","R elationshi p"))
495	"DATA",900 2313.91,11 ,20,0)
496	^9002313.9 102^1^1^31 01101
497	"DATA",900 2313.91,11 ,20,1,0)
498	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
499	"DATA",900 2313.91,11 ,25,0)
500	^9002313.9 104^1^1^30 40114^^^
501	"DATA",900 2313.91,11 ,25,1,0)
502	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
503	"DATA",900 2313.91,11 ,30,0)
504	^9002313.9 103^1^1^30 40114^^^^
505	"DATA",900 2313.91,11 ,30,1,0)
506	S $P(^BPSC (BPS(90023 13.02),300 ),U,6)=BPS ("X")
507	"DATA",900 2313.91,12 ,0)
508	308^^OTHER COVERAGE CODE^N^^^^ 2^N
509	"DATA",900 2313.91,12 ,5)
510	C8^2
511	"DATA",900 2313.91,12 ,10,0)
512	^9002313.9 101^2^2^31 01115^
513	"DATA",900 2313.91,12 ,10,1,0)
514	S BPS("X") =$G(BPS("P atient","O ther Cover age Code") )
515	"DATA",900 2313.91,12 ,10,2,0)
516	S:'BPS("X" ) BPS("X") =0
517	"DATA",900 2313.91,12 ,20,0)
518	^9002313.9 102^1^1^31 01101
519	"DATA",900 2313.91,12 ,20,1,0)
520	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
521	"DATA",900 2313.91,12 ,25,0)
522	^9002313.9 104^1^1^30 40114^^^^
523	"DATA",900 2313.91,12 ,25,1,0)
524	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
525	"DATA",900 2313.91,12 ,30,0)
526	^9002313.9 103^1^1^31 01115^^^
527	"DATA",900 2313.91,12 ,30,1,0)
528	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 00),U,8)=B PS("X")
529	"DATA",900 2313.91,13 ,0)
530	401^^DATE OF SERVICE ^N^^^^8^N
531	"DATA",900 2313.91,13 ,5)
532	D1^8
533	"DATA",900 2313.91,13 ,10,0)
534	^^1^1^3121 128
535	"DATA",900 2313.91,13 ,10,1,0)
536	S BPS("X") =$G(BPS("N CPDP","DOS "))
537	"DATA",900 2313.91,13 ,20,0)
538	^9002313.9 102^1^1^31 01101
539	"DATA",900 2313.91,13 ,20,1,0)
540	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
541	"DATA",900 2313.91,13 ,25,0)
542	^9002313.9 104^1^1^30 40113^^^^
543	"DATA",900 2313.91,13 ,25,1,0)
544	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
545	"DATA",900 2313.91,13 ,30,0)
546	^^1^1^3121 128
547	"DATA",900 2313.91,13 ,30,1,0)
548	S $P(^BPSC (BPS(90023 13.02),401 ),U,1)=BPS ("X")
549	"DATA",900 2313.91,14 ,0)
550	307^^PLACE OF SERVIC E^A/N^^^^2 ^N
551	"DATA",900 2313.91,14 ,5)
552	C7^2
553	"DATA",900 2313.91,14 ,10,0)
554	^9002313.9 101^1^1^30 40820
555	"DATA",900 2313.91,14 ,10,1,0)
556	S BPS("X") =$G(BPS("P atient","P lace of Se rvice"))
557	"DATA",900 2313.91,14 ,20,0)
558	^9002313.9 102^1^1^31 01101
559	"DATA",900 2313.91,14 ,20,1,0)
560	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
561	"DATA",900 2313.91,14 ,25,0)
562	^9002313.9 104^1^1^30 61121^
563	"DATA",900 2313.91,14 ,25,1,0)
564	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
565	"DATA",900 2313.91,14 ,30,0)
566	^9002313.9 103^1^1^31 00910^^^^
567	"DATA",900 2313.91,14 ,30,1,0)
568	S $P(^BPSC (BPS(90023 13.02),300 ),U,7)=BPS ("X")
569	"DATA",900 2313.91,15 ,0)
570	309^^ELIGI BILITY CLA RIFICATION CODE^N^^^ ^1^N
571	"DATA",900 2313.91,15 ,5)
572	C9^1
573	"DATA",900 2313.91,15 ,10,0)
574	^^2^2^3110 727^
575	"DATA",900 2313.91,15 ,10,1,0)
576	S BPS("X") =$G(BPS("I nsurer","E ligibility Clarifica tion Code" ))
577	"DATA",900 2313.91,15 ,10,2,0)
578	S:BPS("X") ="" BPS("X ")=0
579	"DATA",900 2313.91,15 ,20,0)
580	^9002313.9 102^1^1^31 01101
581	"DATA",900 2313.91,15 ,20,1,0)
582	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
583	"DATA",900 2313.91,15 ,25,0)
584	^9002313.9 104^1^1^30 61121^
585	"DATA",900 2313.91,15 ,25,1,0)
586	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
587	"DATA",900 2313.91,15 ,30,0)
588	^9002313.9 103^1^1^30 40114^^^^
589	"DATA",900 2313.91,15 ,30,1,0)
590	S $P(^BPSC (BPS(90023 13.02),300 ),U,9)=BPS ("X")
591	"DATA",900 2313.91,16 ,0)
592	310^^PATIE NT FIRST N AME^A/N^^^ ^12^A/N
593	"DATA",900 2313.91,16 ,5)
594	CA^12
595	"DATA",900 2313.91,16 ,10,0)
596	^^1^1^3101 216^
597	"DATA",900 2313.91,16 ,10,1,0)
598	S BPS("X") =$G(BPS("P atient","F irst Name" ))
599	"DATA",900 2313.91,16 ,20,0)
600	^9002313.9 102^1^1^31 01101
601	"DATA",900 2313.91,16 ,20,1,0)
602	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 2)
603	"DATA",900 2313.91,16 ,25,0)
604	^9002313.9 104^1^1^30 61121^
605	"DATA",900 2313.91,16 ,25,1,0)
606	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 2)
607	"DATA",900 2313.91,16 ,30,0)
608	^9002313.9 103^1^1^31 01004^^^^
609	"DATA",900 2313.91,16 ,30,1,0)
610	S $P(^BPSC (BPS(90023 13.02),300 ),U,10)=BP S("X")
611	"DATA",900 2313.91,17 ,0)
612	311^^PATIE NT LAST NA ME^A/N^^^^ 15^A/N
613	"DATA",900 2313.91,17 ,5)
614	CB^15
615	"DATA",900 2313.91,17 ,10,0)
616	^^1^1^3101 216^
617	"DATA",900 2313.91,17 ,10,1,0)
618	S BPS("X") =$G(BPS("P atient","L ast Name") )
619	"DATA",900 2313.91,17 ,20,0)
620	^9002313.9 102^1^1^31 01004^
621	"DATA",900 2313.91,17 ,20,1,0)
622	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
623	"DATA",900 2313.91,17 ,25,0)
624	^9002313.9 104^1^1^31 01004^^^
625	"DATA",900 2313.91,17 ,25,1,0)
626	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
627	"DATA",900 2313.91,17 ,30,0)
628	^9002313.9 103^1^1^31 01004^^^
629	"DATA",900 2313.91,17 ,30,1,0)
630	S $P(^BPSC (BPS(90023 13.02),300 ),U,11)=$G (BPS("X"))
631	"DATA",900 2313.91,18 ,0)
632	402^^PRESC RIPTION/SE RVICE REF NO^N^^^^12 ^N
633	"DATA",900 2313.91,18 ,1)
634	PRESCRIPTI ON/SERVICE REFERENCE NUMBER
635	"DATA",900 2313.91,18 ,5)
636	D2^7
637	"DATA",900 2313.91,18 ,10,0)
638	^9002313.9 101^1^1^31 01115^^^^
639	"DATA",900 2313.91,18 ,10,1,0)
640	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"RX IEN") )
641	"DATA",900 2313.91,18 ,20,0)
642	^^2^2^3121 128
643	"DATA",900 2313.91,18 ,20,1,0)
644	I $L($G(BP S("X")))>1 2 S BPS("X ")=$E(BPS( "X"),$L(BP S("X"))-11 ,$L(BPS("X ")))
645	"DATA",900 2313.91,18 ,20,2,0)
646	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),12 )
647	"DATA",900 2313.91,18 ,25,0)
648	^9002313.9 104^2^2^31 01006^^^^
649	"DATA",900 2313.91,18 ,25,1,0)
650	I $L(BPS(" X"))>7 S B PS("X")=$E (BPS("X"), $L(BPS("X" ))-6,$L(BP S("X")))
651	"DATA",900 2313.91,18 ,25,2,0)
652	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),7)
653	"DATA",900 2313.91,18 ,30,0)
654	^9002313.9 103^1^1^31 01115^^^^
655	"DATA",900 2313.91,18 ,30,1,0)
656	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,2)=B PS("X")
657	"DATA",900 2313.91,19 ,0)
658	403^^FILL NUMBER^N^^ ^^2^N
659	"DATA",900 2313.91,19 ,5)
660	D3^2
661	"DATA",900 2313.91,19 ,10,0)
662	^9002313.9 101^1^1^30 30718
663	"DATA",900 2313.91,19 ,10,1,0)
664	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Refill # "))
665	"DATA",900 2313.91,19 ,20,0)
666	^9002313.9 102^1^1^31 01101
667	"DATA",900 2313.91,19 ,20,1,0)
668	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
669	"DATA",900 2313.91,19 ,25,0)
670	^9002313.9 104^1^1^30 30718^^
671	"DATA",900 2313.91,19 ,25,1,0)
672	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
673	"DATA",900 2313.91,19 ,30,0)
674	1^9002313. 9103^1^1^3 030718^^^
675	"DATA",900 2313.91,19 ,30,1,0)
676	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,3)=B PS("X")
677	"DATA",900 2313.91,20 ,0)
678	B87^^QUAN LIMIT PER SPC TM PD COUNT^^^^^ 1^N
679	"DATA",900 2313.91,20 ,1)
680	QUANTITY L IMIT PER S PECIFIC TI ME PERIOD COUNT
681	"DATA",900 2313.91,20 ,5)
682	3P^^2087
683	"DATA",900 2313.91,20 ,10,0)
684	^9002313.9 101^1^1^31 50915^^
685	"DATA",900 2313.91,20 ,10,1,0)
686	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
687	"DATA",900 2313.91,21 ,0)
688	405^^DAYS SUPPLY^N^^ ^^3^N
689	"DATA",900 2313.91,21 ,5)
690	D5^3
691	"DATA",900 2313.91,21 ,10,0)
692	^9002313.9 101^1^1^30 40109
693	"DATA",900 2313.91,21 ,10,1,0)
694	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Days Sup ply"))
695	"DATA",900 2313.91,21 ,20,0)
696	^9002313.9 102^1^1^31 01101
697	"DATA",900 2313.91,21 ,20,1,0)
698	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),3)
699	"DATA",900 2313.91,21 ,25,0)
700	^9002313.9 104^1^1^30 30827^^^^
701	"DATA",900 2313.91,21 ,25,1,0)
702	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),3)
703	"DATA",900 2313.91,21 ,30,0)
704	^9002313.9 103^1^1^30 30827^^^^
705	"DATA",900 2313.91,21 ,30,1,0)
706	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,5)=B PS("X")
707	"DATA",900 2313.91,22 ,0)
708	406^^COMPO UND CODE^N ^^^^1^N
709	"DATA",900 2313.91,22 ,5)
710	D6^407
711	"DATA",900 2313.91,22 ,10,0)
712	^9002313.9 101^2^2^30 40114
713	"DATA",900 2313.91,22 ,10,1,0)
714	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Compound Code"))
715	"DATA",900 2313.91,22 ,10,2,0)
716	S:BPS("X") ="" BPS("X ")=1
717	"DATA",900 2313.91,22 ,20,0)
718	^9002313.9 102^1^1^31 01101
719	"DATA",900 2313.91,22 ,20,1,0)
720	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
721	"DATA",900 2313.91,22 ,25,0)
722	^9002313.9 104^1^1^30 40114^^^^
723	"DATA",900 2313.91,22 ,25,1,0)
724	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
725	"DATA",900 2313.91,22 ,30,0)
726	^9002313.9 103^1^1^30 40114^^^^
727	"DATA",900 2313.91,22 ,30,1,0)
728	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,6)=B PS("X")
729	"DATA",900 2313.91,23 ,0)
730	407^^PRODU CT/SERVICE ID^A/N^^^ ^19^A/N
731	"DATA",900 2313.91,23 ,5)
732	D7^19
733	"DATA",900 2313.91,23 ,10,0)
734	^9002313.9 101^2^2^30 30825
735	"DATA",900 2313.91,23 ,10,1,0)
736	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"NDC"))
737	"DATA",900 2313.91,23 ,10,2,0)
738	S BPS("X") =$$NDCF^BP SECFM(BPS( "X"))
739	"DATA",900 2313.91,23 ,20,0)
740	^9002313.9 102^1^1^31 01101
741	"DATA",900 2313.91,23 ,20,1,0)
742	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 9)
743	"DATA",900 2313.91,23 ,25,0)
744	^9002313.9 104^1^1^30 30825^^^
745	"DATA",900 2313.91,23 ,25,1,0)
746	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 9)
747	"DATA",900 2313.91,23 ,30,0)
748	^9002313.9 103^1^1^30 30825^^^^
749	"DATA",900 2313.91,23 ,30,1,0)
750	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,7)=B PS("X")
751	"DATA",900 2313.91,24 ,0)
752	408^^DAW P RODUCT SEL ECTION COD E^N^^^^1^A /N
753	"DATA",900 2313.91,24 ,1)
754	DISPENSE A S WRITTEN (DAW)/ PRO DUCT SELEC TION CODE
755	"DATA",900 2313.91,24 ,5)
756	D8^1
757	"DATA",900 2313.91,24 ,10,0)
758	^9002313.9 101^2^2^30 70205
759	"DATA",900 2313.91,24 ,10,1,0)
760	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"DAW"))
761	"DATA",900 2313.91,24 ,10,2,0)
762	S:BPS("X") ="" BPS("X ")=0
763	"DATA",900 2313.91,24 ,20,0)
764	^9002313.9 102^1^1^31 01101
765	"DATA",900 2313.91,24 ,20,1,0)
766	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
767	"DATA",900 2313.91,24 ,25,0)
768	^9002313.9 104^1^1^30 61120^
769	"DATA",900 2313.91,24 ,25,1,0)
770	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
771	"DATA",900 2313.91,24 ,30,0)
772	^9002313.9 103^1^1^30 30722^
773	"DATA",900 2313.91,24 ,30,1,0)
774	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,8)=B PS("X")
775	"DATA",900 2313.91,25 ,0)
776	409^^INGRE DIENT COST SUBMITTED ^D^^^^8^D
777	"DATA",900 2313.91,25 ,5)
778	D9^8
779	"DATA",900 2313.91,25 ,10,0)
780	^^1^1^3121 128
781	"DATA",900 2313.91,25 ,10,1,0)
782	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Ingredie nt Cost"))
783	"DATA",900 2313.91,25 ,20,0)
784	^9002313.9 102^1^1^31 01101
785	"DATA",900 2313.91,25 ,20,1,0)
786	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
787	"DATA",900 2313.91,25 ,25,0)
788	^9002313.9 104^1^1^30 40907^^^^
789	"DATA",900 2313.91,25 ,25,1,0)
790	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
791	"DATA",900 2313.91,25 ,30,0)
792	^9002313.9 103^1^1^30 40907^^^^
793	"DATA",900 2313.91,25 ,30,1,0)
794	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,9)=B PS("X")
795	"DATA",900 2313.91,26 ,0)
796	411^^PRESC RIBER ID^A /N^^^^15^A /N
797	"DATA",900 2313.91,26 ,5)
798	DB^15
799	"DATA",900 2313.91,26 ,10,0)
800	^9002313.9 101^1^1^30 70214
801	"DATA",900 2313.91,26 ,10,1,0)
802	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Prescrib er NPI"))
803	"DATA",900 2313.91,26 ,20,0)
804	^9002313.9 102^1^1^31 01101
805	"DATA",900 2313.91,26 ,20,1,0)
806	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
807	"DATA",900 2313.91,26 ,25,0)
808	^9002313.9 104^1^1^30 70214^
809	"DATA",900 2313.91,26 ,25,1,0)
810	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
811	"DATA",900 2313.91,26 ,30,0)
812	^9002313.9 103^1^1^30 30823^^^^
813	"DATA",900 2313.91,26 ,30,1,0)
814	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,11)= BPS("X")
815	"DATA",900 2313.91,27 ,0)
816	414^^DATE PRESCRIPTI ON WRITTEN ^N^^^^8^N
817	"DATA",900 2313.91,27 ,5)
818	DE^8
819	"DATA",900 2313.91,27 ,10,0)
820	^9002313.9 101^1^1^30 40913
821	"DATA",900 2313.91,27 ,10,1,0)
822	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Date Wri tten"))
823	"DATA",900 2313.91,27 ,20,0)
824	^9002313.9 102^1^1^31 01101
825	"DATA",900 2313.91,27 ,20,1,0)
826	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
827	"DATA",900 2313.91,27 ,25,0)
828	^9002313.9 104^1^1^30 40913^^^^
829	"DATA",900 2313.91,27 ,25,1,0)
830	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
831	"DATA",900 2313.91,27 ,30,0)
832	^9002313.9 103^1^1^30 40913^^^^
833	"DATA",900 2313.91,27 ,30,1,0)
834	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,14)= BPS("X")
835	"DATA",900 2313.91,28 ,0)
836	415^^NUMBE R OF REFIL LS AUTHORI ZED^N^^^^2 ^N
837	"DATA",900 2313.91,28 ,5)
838	DF^2
839	"DATA",900 2313.91,28 ,10,0)
840	^9002313.9 101^1^1^30 30718
841	"DATA",900 2313.91,28 ,10,1,0)
842	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"# Refill s"))
843	"DATA",900 2313.91,28 ,20,0)
844	^9002313.9 102^1^1^31 01101
845	"DATA",900 2313.91,28 ,20,1,0)
846	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
847	"DATA",900 2313.91,28 ,25,0)
848	^9002313.9 104^1^1^30 30718^^
849	"DATA",900 2313.91,28 ,25,1,0)
850	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
851	"DATA",900 2313.91,28 ,30,0)
852	^9002313.9 103^1^1^30 30718^^^^
853	"DATA",900 2313.91,28 ,30,1,0)
854	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,15)= BPS("X")
855	"DATA",900 2313.91,29 ,0)
856	419^^PRESC RIPTION OR IGIN CODE^ N^^^^1^N
857	"DATA",900 2313.91,29 ,5)
858	DJ^1
859	"DATA",900 2313.91,29 ,10,0)
860	^9002313.9 101^2^2^30 30721
861	"DATA",900 2313.91,29 ,10,1,0)
862	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Origin C ode"))
863	"DATA",900 2313.91,29 ,10,2,0)
864	S:BPS("X") ="" BPS("X ")="0"
865	"DATA",900 2313.91,29 ,20,0)
866	^9002313.9 102^1^1^31 01101
867	"DATA",900 2313.91,29 ,20,1,0)
868	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
869	"DATA",900 2313.91,29 ,25,0)
870	^9002313.9 104^1^1^30 30721^^^^
871	"DATA",900 2313.91,29 ,25,1,0)
872	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
873	"DATA",900 2313.91,29 ,30,0)
874	^9002313.9 103^1^1^30 30721^^^^
875	"DATA",900 2313.91,29 ,30,1,0)
876	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,19)= BPS("X")
877	"DATA",900 2313.91,30 ,0)
878	420^^SUBMI SSION CLAR IFICATION CODE^N^^^^ 2^N
879	"DATA",900 2313.91,30 ,5)
880	DK^2
881	"DATA",900 2313.91,30 ,10,0)
882	^9002313.9 101^1^1^31 01006^^^^
883	"DATA",900 2313.91,30 ,10,1,0)
884	; GET CODE handled b y FLD420^B PSOSSG
885	"DATA",900 2313.91,30 ,20,0)
886	^9002313.9 102^1^1^31 01006^^^^
887	"DATA",900 2313.91,30 ,20,1,0)
888	; vD.0 FOR MAT CODE h andled by FLD420^BPS OSSG
889	"DATA",900 2313.91,30 ,25,0)
890	^9002313.9 104^1^1^31 01006^^^^
891	"DATA",900 2313.91,30 ,25,1,0)
892	; FORMAT C ODE handle d by FLD42 0^BPSOSSG
893	"DATA",900 2313.91,30 ,30,0)
894	^9002313.9 103^1^1^31 01006^^^^
895	"DATA",900 2313.91,30 ,30,1,0)
896	D FLD420^B PSOSSG
897	"DATA",900 2313.91,31 ,0)
898	453^^ORIG PRESCR PRO D/SERV ID QUAL^N^^^^ 2^A/N
899	"DATA",900 2313.91,31 ,1)
900	ORIGINALLY PRESCRIBE D PRODUCT/ SERVICE ID QUALIFIER
901	"DATA",900 2313.91,31 ,5)
902	EJ^2
903	"DATA",900 2313.91,31 ,10,0)
904	^9002313.9 101^1^1^30 40907
905	"DATA",900 2313.91,31 ,10,1,0)
906	S BPS("X") =""
907	"DATA",900 2313.91,31 ,20,0)
908	^9002313.9 102^1^1^31 01101
909	"DATA",900 2313.91,31 ,20,1,0)
910	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
911	"DATA",900 2313.91,31 ,25,0)
912	^9002313.9 104^1^1^30 40907^^^^
913	"DATA",900 2313.91,31 ,25,1,0)
914	S BPS("X") =$$NFF^BPS ECFM(BPS(" X"),2)
915	"DATA",900 2313.91,31 ,30,0)
916	^9002313.9 103^1^1^30 40907^^^
917	"DATA",900 2313.91,31 ,30,1,0)
918	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 50),U,3)=" "
919	"DATA",900 2313.91,32 ,0)
920	B88^^QUAN LIMIT PER SPC TIME P ERIOD^^^^^ 10^N
921	"DATA",900 2313.91,32 ,1)
922	QUANTITY L IMIT PER S PECIFIC TI ME PERIOD
923	"DATA",900 2313.91,32 ,5)
924	3R^^2088
925	"DATA",900 2313.91,32 ,10,0)
926	^^1^1^3150 915^
927	"DATA",900 2313.91,32 ,10,1,0)
928	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
929	"DATA",900 2313.91,33 ,0)
930	423^^BASIS OF COST D ETERMINATI ON^A/N^^^^ 2^A/N
931	"DATA",900 2313.91,33 ,5)
932	DN^2
933	"DATA",900 2313.91,33 ,10,0)
934	^9002313.9 101^1^1^30 30916
935	"DATA",900 2313.91,33 ,10,1,0)
936	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Basis of Cost Dete rmination" ))
937	"DATA",900 2313.91,33 ,20,0)
938	^9002313.9 102^1^1^31 01101
939	"DATA",900 2313.91,33 ,20,1,0)
940	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
941	"DATA",900 2313.91,33 ,25,0)
942	^9002313.9 104^1^1^30 61121^
943	"DATA",900 2313.91,33 ,25,1,0)
944	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
945	"DATA",900 2313.91,33 ,30,0)
946	^9002313.9 103^1^1^30 30916^^^^
947	"DATA",900 2313.91,33 ,30,1,0)
948	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,23)= BPS("X")
949	"DATA",900 2313.91,34 ,0)
950	424^^DIAGN OSIS CODE^ A/N^^^^15^ A/N
951	"DATA",900 2313.91,34 ,5)
952	DO^15
953	"DATA",900 2313.91,34 ,10,0)
954	^9002313.9 101^1^1^30 30718
955	"DATA",900 2313.91,34 ,10,1,0)
956	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Diagnosi s Code"))
957	"DATA",900 2313.91,34 ,20,0)
958	^9002313.9 102^1^1^31 01101
959	"DATA",900 2313.91,34 ,20,1,0)
960	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
961	"DATA",900 2313.91,34 ,25,0)
962	^9002313.9 104^1^1^30 61122^
963	"DATA",900 2313.91,34 ,25,1,0)
964	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
965	"DATA",900 2313.91,34 ,30,0)
966	^9002313.9 103^1^1^30 30718^^
967	"DATA",900 2313.91,34 ,30,1,0)
968	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,24)= BPS("X")
969	"DATA",900 2313.91,35 ,0)
970	430^^GROSS AMOUNT DU E^D^^^^8^D
971	"DATA",900 2313.91,35 ,5)
972	DU^8
973	"DATA",900 2313.91,35 ,10,0)
974	^9002313.9 101^1^1^30 30722
975	"DATA",900 2313.91,35 ,10,1,0)
976	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Gross Am ount Due") )
977	"DATA",900 2313.91,35 ,20,0)
978	^9002313.9 102^1^1^31 01101
979	"DATA",900 2313.91,35 ,20,1,0)
980	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
981	"DATA",900 2313.91,35 ,25,0)
982	^9002313.9 104^1^1^30 61122^
983	"DATA",900 2313.91,35 ,25,1,0)
984	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
985	"DATA",900 2313.91,35 ,30,0)
986	^9002313.9 103^1^1^30 30722^^^^
987	"DATA",900 2313.91,35 ,30,1,0)
988	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,30)= BPS("X")
989	"DATA",900 2313.91,36 ,0)
990	433^^PATIE NT PAID AM OUNT SUBMI TTED^D^^^^ 8^D
991	"DATA",900 2313.91,36 ,1)
992	PATIENT PA ID AMOUNT SUBMITTED
993	"DATA",900 2313.91,36 ,5)
994	DX^8
995	"DATA",900 2313.91,36 ,10,0)
996	^^2^2^3110 727^
997	"DATA",900 2313.91,36 ,10,1,0)
998	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Patient Paid Amoun t"))
999	"DATA",900 2313.91,36 ,10,2,0)
1000	S:BPS("X") ="" BPS("X ")="0.00"
1001	"DATA",900 2313.91,36 ,20,0)
1002	^9002313.9 102^1^1^31 01101
1003	"DATA",900 2313.91,36 ,20,1,0)
1004	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
1005	"DATA",900 2313.91,36 ,25,0)
1006	^9002313.9 104^1^1^30 61122^
1007	"DATA",900 2313.91,36 ,25,1,0)
1008	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
1009	"DATA",900 2313.91,36 ,30,0)
1010	^9002313.9 103^1^1^30 30916^^
1011	"DATA",900 2313.91,36 ,30,1,0)
1012	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 30),U,3)=B PS("X")
1013	"DATA",900 2313.91,37 ,0)
1014	439^^REASO N FOR SERV ICE CODE^A /N^^^^2^A/ N
1015	"DATA",900 2313.91,37 ,5)
1016	E4^2
1017	"DATA",900 2313.91,37 ,10,0)
1018	^9002313.9 101^1^1^30 31230
1019	"DATA",900 2313.91,37 ,10,1,0)
1020	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"DUR","DU R Conflict Code",439 ))
1021	"DATA",900 2313.91,37 ,20,0)
1022	^9002313.9 102^1^1^31 01101
1023	"DATA",900 2313.91,37 ,20,1,0)
1024	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1025	"DATA",900 2313.91,37 ,25,0)
1026	^9002313.9 104^1^1^30 31230^^
1027	"DATA",900 2313.91,37 ,25,1,0)
1028	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1029	"DATA",900 2313.91,37 ,30,0)
1030	^9002313.9 103^1^1^31 01115^^^^
1031	"DATA",900 2313.91,37 ,30,1,0)
1032	D FLD439^B PSOSSG
1033	"DATA",900 2313.91,38 ,0)
1034	440^^PROFE SSIONAL SE RVICE CODE ^A/N^^^^2^ A/N
1035	"DATA",900 2313.91,38 ,5)
1036	E5^2
1037	"DATA",900 2313.91,38 ,10,0)
1038	^9002313.9 101^1^1^30 31230
1039	"DATA",900 2313.91,38 ,10,1,0)
1040	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"DUR","DU R Interven tion Code" ,440))
1041	"DATA",900 2313.91,38 ,20,0)
1042	^9002313.9 102^1^1^31 01101
1043	"DATA",900 2313.91,38 ,20,1,0)
1044	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1045	"DATA",900 2313.91,38 ,25,0)
1046	^9002313.9 104^1^1^30 61122^
1047	"DATA",900 2313.91,38 ,25,1,0)
1048	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1049	"DATA",900 2313.91,38 ,30,0)
1050	^9002313.9 103^1^1^31 01115^
1051	"DATA",900 2313.91,38 ,30,1,0)
1052	D FLD440^B PSOSSG
1053	"DATA",900 2313.91,39 ,0)
1054	441^^RESUL T OF SERVI CE CODE^A/ N^^^^2^A/N
1055	"DATA",900 2313.91,39 ,5)
1056	E6^2
1057	"DATA",900 2313.91,39 ,10,0)
1058	^9002313.9 101^2^2^30 70214
1059	"DATA",900 2313.91,39 ,10,1,0)
1060	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"DUR","DU R Outcome Code",441) )
1061	"DATA",900 2313.91,39 ,10,2,0)
1062	S:BPS("X") ="" BPS("X ")="00"
1063	"DATA",900 2313.91,39 ,20,0)
1064	^9002313.9 102^1^1^31 01101
1065	"DATA",900 2313.91,39 ,20,1,0)
1066	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1067	"DATA",900 2313.91,39 ,25,0)
1068	^9002313.9 104^1^1^30 70214^^
1069	"DATA",900 2313.91,39 ,25,1,0)
1070	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1071	"DATA",900 2313.91,39 ,30,0)
1072	^9002313.9 103^1^1^31 01115^
1073	"DATA",900 2313.91,39 ,30,1,0)
1074	D FLD441^B PSOSSG
1075	"DATA",900 2313.91,40 ,0)
1076	442^^QUANT ITY DISPEN SED^N^^^^1 0^N
1077	"DATA",900 2313.91,40 ,5)
1078	E7^10
1079	"DATA",900 2313.91,40 ,10,0)
1080	^9002313.9 101^1^1^30 70620
1081	"DATA",900 2313.91,40 ,10,1,0)
1082	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Quantity "))*1000\1
1083	"DATA",900 2313.91,40 ,20,0)
1084	^9002313.9 102^1^1^31 01101
1085	"DATA",900 2313.91,40 ,20,1,0)
1086	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
1087	"DATA",900 2313.91,40 ,25,0)
1088	^9002313.9 104^1^1^30 61122^
1089	"DATA",900 2313.91,40 ,25,1,0)
1090	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
1091	"DATA",900 2313.91,40 ,30,0)
1092	^9002313.9 103^1^1^30 40109^^^^
1093	"DATA",900 2313.91,40 ,30,1,0)
1094	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 40),U,2)=B PS("X")
1095	"DATA",900 2313.91,41 ,0)
1096	B89^^QUANT ITY LIMIT TIME PERIO D^^^^^5^N
1097	"DATA",900 2313.91,41 ,1)
1098	QUANTITY L IMIT TIME PERIOD
1099	"DATA",900 2313.91,41 ,5)
1100	3S^^2089
1101	"DATA",900 2313.91,41 ,10,0)
1102	^^1^1^3150 915^
1103	"DATA",900 2313.91,41 ,10,1,0)
1104	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
1105	"DATA",900 2313.91,42 ,0)
1106	412^^DISPE NSING FEE SUBMITTED^ D^^^^8^D
1107	"DATA",900 2313.91,42 ,5)
1108	DC^8
1109	"DATA",900 2313.91,42 ,10,0)
1110	^^1^1^3121 128
1111	"DATA",900 2313.91,42 ,10,1,0)
1112	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Dispensi ng Fee"))
1113	"DATA",900 2313.91,42 ,20,0)
1114	^9002313.9 102^1^1^31 01101
1115	"DATA",900 2313.91,42 ,20,1,0)
1116	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
1117	"DATA",900 2313.91,42 ,25,0)
1118	^9002313.9 104^1^1^30 61121^
1119	"DATA",900 2313.91,42 ,25,1,0)
1120	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
1121	"DATA",900 2313.91,42 ,30,0)
1122	^9002313.9 103^1^1^30 40907^^^^
1123	"DATA",900 2313.91,42 ,30,1,0)
1124	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,12)= BPS("X")
1125	"DATA",900 2313.91,43 ,0)
1126	B90^^DAYS SUP LIM PE R SPC TM P D CNT^^^^^ 1^N
1127	"DATA",900 2313.91,43 ,1)
1128	DAYS SUPPL Y LIMIT PE R SPECIFIC TIME PERI OD COUNT
1129	"DATA",900 2313.91,43 ,5)
1130	3T^^2090
1131	"DATA",900 2313.91,43 ,10,0)
1132	^^1^1^3150 915^
1133	"DATA",900 2313.91,43 ,10,1,0)
1134	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
1135	"DATA",900 2313.91,44 ,0)
1136	418^^LEVEL OF SERVIC E^N^^^^2^N
1137	"DATA",900 2313.91,44 ,5)
1138	DI^2
1139	"DATA",900 2313.91,44 ,10,0)
1140	^9002313.9 101^2^2^31 01115^
1141	"DATA",900 2313.91,44 ,10,1,0)
1142	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Level of Service") )
1143	"DATA",900 2313.91,44 ,10,2,0)
1144	S:BPS("X") ="" BPS("X ")=0
1145	"DATA",900 2313.91,44 ,20,0)
1146	^9002313.9 102^1^1^31 01101
1147	"DATA",900 2313.91,44 ,20,1,0)
1148	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
1149	"DATA",900 2313.91,44 ,25,0)
1150	^9002313.9 104^1^1^30 70215^^
1151	"DATA",900 2313.91,44 ,25,1,0)
1152	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
1153	"DATA",900 2313.91,44 ,30,0)
1154	^9002313.9 103^1^1^30 70215^^^^
1155	"DATA",900 2313.91,44 ,30,1,0)
1156	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,18)= BPS("X")
1157	"DATA",900 2313.91,45 ,0)
1158	421^^PRIMA RY CARE PR OVIDER ID^ A/N^^^^15^ A/N
1159	"DATA",900 2313.91,45 ,5)
1160	DL^15
1161	"DATA",900 2313.91,45 ,10,0)
1162	^9002313.9 101^1^1^31 01115^
1163	"DATA",900 2313.91,45 ,10,1,0)
1164	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Primary Care Provi der NPI"))
1165	"DATA",900 2313.91,45 ,20,0)
1166	^9002313.9 102^1^1^31 01101
1167	"DATA",900 2313.91,45 ,20,1,0)
1168	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
1169	"DATA",900 2313.91,45 ,25,0)
1170	^9002313.9 104^1^1^30 70214^
1171	"DATA",900 2313.91,45 ,25,1,0)
1172	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
1173	"DATA",900 2313.91,45 ,30,0)
1174	^9002313.9 103^1^1^30 41015^
1175	"DATA",900 2313.91,45 ,30,1,0)
1176	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,21)= ""
1177	"DATA",900 2313.91,46 ,0)
1178	426^^USUAL AND CUSTO MARY CHARG E^D^^^^8^D
1179	"DATA",900 2313.91,46 ,5)
1180	DQ^8
1181	"DATA",900 2313.91,46 ,10,0)
1182	^9002313.9 101^1^1^30 31219
1183	"DATA",900 2313.91,46 ,10,1,0)
1184	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Usual & Customary" ))
1185	"DATA",900 2313.91,46 ,20,0)
1186	^9002313.9 102^1^1^31 01101
1187	"DATA",900 2313.91,46 ,20,1,0)
1188	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
1189	"DATA",900 2313.91,46 ,25,0)
1190	^9002313.9 104^1^1^30 31219^^^^
1191	"DATA",900 2313.91,46 ,25,1,0)
1192	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
1193	"DATA",900 2313.91,46 ,30,0)
1194	^9002313.9 103^1^1^30 31219^^^^
1195	"DATA",900 2313.91,46 ,30,1,0)
1196	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,26)= BPS("X")
1197	"DATA",900 2313.91,47 ,0)
1198	429^^SPECI AL PACKAGI NG INDICAT OR^N^^^^1^ N
1199	"DATA",900 2313.91,47 ,5)
1200	DT^1
1201	"DATA",900 2313.91,47 ,10,0)
1202	^9002313.9 101^2^2^31 01115^
1203	"DATA",900 2313.91,47 ,10,1,0)
1204	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Unit Dos e Indicato r"))
1205	"DATA",900 2313.91,47 ,10,2,0)
1206	S:BPS("X") ="" BPS("X ")=0
1207	"DATA",900 2313.91,47 ,20,0)
1208	^9002313.9 102^1^1^31 01101
1209	"DATA",900 2313.91,47 ,20,1,0)
1210	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
1211	"DATA",900 2313.91,47 ,25,0)
1212	^9002313.9 104^1^1^30 61122^
1213	"DATA",900 2313.91,47 ,25,1,0)
1214	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
1215	"DATA",900 2313.91,47 ,30,0)
1216	^9002313.9 103^1^1^30 30823^^^
1217	"DATA",900 2313.91,47 ,30,1,0)
1218	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,29)= BPS("X")
1219	"DATA",900 2313.91,48 ,0)
1220	431^^OTHER PAYER AMO UNT PAID^D ^^^^8^D
1221	"DATA",900 2313.91,48 ,5)
1222	DV^8
1223	"DATA",900 2313.91,48 ,10,0)
1224	^9002313.9 101^1^1^31 00916
1225	"DATA",900 2313.91,48 ,10,1,0)
1226	;GET code for this C OB field i s executed in COB^BP SOSHF
1227	"DATA",900 2313.91,48 ,20,0)
1228	^9002313.9 102^1^1^31 01101
1229	"DATA",900 2313.91,48 ,20,1,0)
1230	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
1231	"DATA",900 2313.91,48 ,25,0)
1232	^9002313.9 104^1^1^31 01029^
1233	"DATA",900 2313.91,48 ,25,1,0)
1234	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
1235	"DATA",900 2313.91,48 ,30,0)
1236	^9002313.9 103^1^1^31 00824
1237	"DATA",900 2313.91,48 ,30,1,0)
1238	D SET431^B PSFLD01
1239	"DATA",900 2313.91,49 ,0)
1240	438^^INCEN TIVE AMOUN T SUBMITTE D^D^^^^8^D
1241	"DATA",900 2313.91,49 ,5)
1242	E3^8
1243	"DATA",900 2313.91,49 ,10,0)
1244	^^1^1^3110 505^
1245	"DATA",900 2313.91,49 ,10,1,0)
1246	S BPS("X") =0
1247	"DATA",900 2313.91,49 ,20,0)
1248	^9002313.9 102^1^1^31 01101
1249	"DATA",900 2313.91,49 ,20,1,0)
1250	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
1251	"DATA",900 2313.91,49 ,25,0)
1252	^9002313.9 104^1^1^30 61122^
1253	"DATA",900 2313.91,49 ,25,1,0)
1254	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
1255	"DATA",900 2313.91,49 ,30,0)
1256	^9002313.9 103^1^1^30 40907^
1257	"DATA",900 2313.91,49 ,30,1,0)
1258	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 30),U,8)=" "
1259	"DATA",900 2313.91,50 ,0)
1260	B91^^DAYS SUP LIM PE R SPC TM P ERIOD^^^^^ 3^N
1261	"DATA",900 2313.91,50 ,1)
1262	DAYS SUPPL Y LIMIT PE R SPECIFIC TIME PERI OD
1263	"DATA",900 2313.91,50 ,5)
1264	3W^^2091
1265	"DATA",900 2313.91,50 ,10,0)
1266	^^1^1^3150 915^
1267	"DATA",900 2313.91,50 ,10,1,0)
1268	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
1269	"DATA",900 2313.91,51 ,0)
1270	443^^OTHER PAYER DAT E^N^^^^8^N
1271	"DATA",900 2313.91,51 ,5)
1272	E8^8
1273	"DATA",900 2313.91,51 ,10,0)
1274	^9002313.9 101^1^1^31 00916
1275	"DATA",900 2313.91,51 ,10,1,0)
1276	;GET code for this C OB field i s executed in COB^BP SOSHF
1277	"DATA",900 2313.91,51 ,20,0)
1278	^9002313.9 102^1^1^31 01101
1279	"DATA",900 2313.91,51 ,20,1,0)
1280	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
1281	"DATA",900 2313.91,51 ,25,0)
1282	^9002313.9 104^1^1^30 40224^
1283	"DATA",900 2313.91,51 ,25,1,0)
1284	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
1285	"DATA",900 2313.91,51 ,30,0)
1286	^9002313.9 103^1^1^31 00824
1287	"DATA",900 2313.91,51 ,30,1,0)
1288	D SET443^B PSFLD01
1289	"DATA",900 2313.91,52 ,0)
1290	313^^CARDH OLDER LAST NAME^A/N^ ^^^15^A/N
1291	"DATA",900 2313.91,52 ,5)
1292	CD^15
1293	"DATA",900 2313.91,52 ,10,0)
1294	^^1^1^3101 216^
1295	"DATA",900 2313.91,52 ,10,1,0)
1296	S BPS("X") =$G(BPS("C ardholder" ,"Last Nam e"))
1297	"DATA",900 2313.91,52 ,20,0)
1298	^9002313.9 102^1^1^31 01101
1299	"DATA",900 2313.91,52 ,20,1,0)
1300	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
1301	"DATA",900 2313.91,52 ,25,0)
1302	^9002313.9 104^1^1^30 61121^
1303	"DATA",900 2313.91,52 ,25,1,0)
1304	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),15)
1305	"DATA",900 2313.91,52 ,30,0)
1306	^9002313.9 103^1^1^30 30823^^^^
1307	"DATA",900 2313.91,52 ,30,1,0)
1308	S $P(^BPSC (BPS(90023 13.02),300 ),U,13)=BP S("X")
1309	"DATA",900 2313.91,53 ,0)
1310	312^^CARDH OLDER FIRS T NAME^A/N ^^^^12^A/N
1311	"DATA",900 2313.91,53 ,5)
1312	CC^12
1313	"DATA",900 2313.91,53 ,10,0)
1314	^^1^1^3101 216^
1315	"DATA",900 2313.91,53 ,10,1,0)
1316	S BPS("X") =$G(BPS("C ardholder" ,"First Na me"))
1317	"DATA",900 2313.91,53 ,20,0)
1318	^9002313.9 102^1^1^31 01101
1319	"DATA",900 2313.91,53 ,20,1,0)
1320	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 2)
1321	"DATA",900 2313.91,53 ,25,0)
1322	^9002313.9 104^1^1^30 61121^
1323	"DATA",900 2313.91,53 ,25,1,0)
1324	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),12)
1325	"DATA",900 2313.91,53 ,30,0)
1326	^9002313.9 103^1^1^31 01115^^^^
1327	"DATA",900 2313.91,53 ,30,1,0)
1328	S $P(^BPSC (BPS(90023 13.02),300 ),U,12)=BP S("X")
1329	"DATA",900 2313.91,54 ,0)
1330	322^^PATIE NT STREET ADDRESS^A/ N^^^^30^A/ N
1331	"DATA",900 2313.91,54 ,5)
1332	CM^30
1333	"DATA",900 2313.91,54 ,10,0)
1334	^9002313.9 101^1^1^30 30718
1335	"DATA",900 2313.91,54 ,10,1,0)
1336	S BPS("X") =$G(BPS("P atient","S treet Addr ess"))
1337	"DATA",900 2313.91,54 ,20,0)
1338	^9002313.9 102^1^1^31 01101
1339	"DATA",900 2313.91,54 ,20,1,0)
1340	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
1341	"DATA",900 2313.91,54 ,25,0)
1342	^9002313.9 104^1^1^30 61121^
1343	"DATA",900 2313.91,54 ,25,1,0)
1344	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),30)
1345	"DATA",900 2313.91,54 ,30,0)
1346	^9002313.9 103^1^1^30 30718^^^^
1347	"DATA",900 2313.91,54 ,30,1,0)
1348	S $P(^BPSC (BPS(90023 13.02),321 ),U,2)=BPS ("X")
1349	"DATA",900 2313.91,55 ,0)
1350	323^^PATIE NT CITY AD DRESS^A/N^ ^^^20^A/N
1351	"DATA",900 2313.91,55 ,5)
1352	CN^20
1353	"DATA",900 2313.91,55 ,10,0)
1354	^9002313.9 101^1^1^30 30703
1355	"DATA",900 2313.91,55 ,10,1,0)
1356	S BPS("X") =$G(BPS("P atient","C ity"))
1357	"DATA",900 2313.91,55 ,20,0)
1358	^9002313.9 102^1^1^31 01101
1359	"DATA",900 2313.91,55 ,20,1,0)
1360	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
1361	"DATA",900 2313.91,55 ,25,0)
1362	^9002313.9 104^1^1^30 61121^
1363	"DATA",900 2313.91,55 ,25,1,0)
1364	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),20)
1365	"DATA",900 2313.91,55 ,30,0)
1366	^9002313.9 103^1^1^30 30703^^^^
1367	"DATA",900 2313.91,55 ,30,1,0)
1368	S $P(^BPSC (BPS(90023 13.02),321 ),U,3)=BPS ("X")
1369	"DATA",900 2313.91,56 ,0)
1370	324^^PATIE NT STATE/P ROVINCE AD DRESS^A/N^ ^^^2^A/N
1371	"DATA",900 2313.91,56 ,5)
1372	CO^2
1373	"DATA",900 2313.91,56 ,10,0)
1374	^9002313.9 101^1^1^30 30717
1375	"DATA",900 2313.91,56 ,10,1,0)
1376	S BPS("X") =$G(BPS("P atient","S tate"))
1377	"DATA",900 2313.91,56 ,20,0)
1378	^9002313.9 102^1^1^31 01101
1379	"DATA",900 2313.91,56 ,20,1,0)
1380	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1381	"DATA",900 2313.91,56 ,25,0)
1382	^9002313.9 104^1^1^30 61121^
1383	"DATA",900 2313.91,56 ,25,1,0)
1384	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),2)
1385	"DATA",900 2313.91,56 ,30,0)
1386	^9002313.9 103^1^1^30 30717^^^^
1387	"DATA",900 2313.91,56 ,30,1,0)
1388	S $P(^BPSC (BPS(90023 13.02),321 ),U,4)=BPS ("X")
1389	"DATA",900 2313.91,57 ,0)
1390	325^^PATIE NT ZIP/POS TAL ZONE^A /N^^^^15^A /N
1391	"DATA",900 2313.91,57 ,5)
1392	CP^15
1393	"DATA",900 2313.91,57 ,10,0)
1394	^9002313.9 101^1^1^30 30718
1395	"DATA",900 2313.91,57 ,10,1,0)
1396	S BPS("X") =$G(BPS("P atient","Z ip"))
1397	"DATA",900 2313.91,57 ,20,0)
1398	^^2^2^3121 128
1399	"DATA",900 2313.91,57 ,20,1,0)
1400	S BPS("X") =$TR($G(BP S("X")),"- /._","")
1401	"DATA",900 2313.91,57 ,20,2,0)
1402	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),15)
1403	"DATA",900 2313.91,57 ,25,0)
1404	^9002313.9 104^2^2^30 30718^^^^
1405	"DATA",900 2313.91,57 ,25,1,0)
1406	S BPS("X") =$TR(BPS(" X"),"-/._" ,"")
1407	"DATA",900 2313.91,57 ,25,2,0)
1408	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),9)
1409	"DATA",900 2313.91,57 ,30,0)
1410	^9002313.9 103^1^1^30 30718^^^^
1411	"DATA",900 2313.91,57 ,30,1,0)
1412	S $P(^BPSC (BPS(90023 13.02),321 ),U,5)=BPS ("X")
1413	"DATA",900 2313.91,58 ,0)
1414	314^^HOME PLAN^A/N^^ ^^3^A/N
1415	"DATA",900 2313.91,58 ,5)
1416	CE^3
1417	"DATA",900 2313.91,58 ,10,0)
1418	^9002313.9 101^1^1^30 30823
1419	"DATA",900 2313.91,58 ,10,1,0)
1420	S BPS("X") =$G(BPS("H ome Plan") )
1421	"DATA",900 2313.91,58 ,20,0)
1422	^9002313.9 102^1^1^31 01101
1423	"DATA",900 2313.91,58 ,20,1,0)
1424	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
1425	"DATA",900 2313.91,58 ,25,0)
1426	^9002313.9 104^1^1^30 61121^
1427	"DATA",900 2313.91,58 ,25,1,0)
1428	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),3)
1429	"DATA",900 2313.91,58 ,30,0)
1430	^9002313.9 103^1^1^30 30823^^^^
1431	"DATA",900 2313.91,58 ,30,1,0)
1432	S $P(^BPSC (BPS(90023 13.02),300 ),U,14)=BP S("X")
1433	"DATA",900 2313.91,59 ,0)
1434	315^^EMPLO YER NAME^A /N^^^^30^A /N
1435	"DATA",900 2313.91,59 ,5)
1436	CF^30
1437	"DATA",900 2313.91,59 ,10,0)
1438	^9002313.9 101^2^2^31 01115^
1439	"DATA",900 2313.91,59 ,10,1,0)
1440	D EMPL^BPS OSSG
1441	"DATA",900 2313.91,59 ,10,2,0)
1442	S BPS("X") =$G(BPS("E mployer"," Name"))
1443	"DATA",900 2313.91,59 ,20,0)
1444	^9002313.9 102^1^1^31 01101
1445	"DATA",900 2313.91,59 ,20,1,0)
1446	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
1447	"DATA",900 2313.91,59 ,25,0)
1448	^9002313.9 104^1^1^30 30718^^^
1449	"DATA",900 2313.91,59 ,25,1,0)
1450	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),30)
1451	"DATA",900 2313.91,59 ,30,0)
1452	^9002313.9 103^1^1^30 61120^
1453	"DATA",900 2313.91,59 ,30,1,0)
1454	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 10),U,5)=B PS("X")
1455	"DATA",900 2313.91,60 ,0)
1456	316^^EMPLO YER STREET ADDRESS^A /N^^^^30^A /N
1457	"DATA",900 2313.91,60 ,5)
1458	CG^30
1459	"DATA",900 2313.91,60 ,10,0)
1460	^9002313.9 101^1^1^30 30718
1461	"DATA",900 2313.91,60 ,10,1,0)
1462	S BPS("X") =$G(BPS("E mployer"," Address"))
1463	"DATA",900 2313.91,60 ,20,0)
1464	^9002313.9 102^1^1^31 01101
1465	"DATA",900 2313.91,60 ,20,1,0)
1466	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
1467	"DATA",900 2313.91,60 ,25,0)
1468	^9002313.9 104^1^1^30 30718^^^
1469	"DATA",900 2313.91,60 ,25,1,0)
1470	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),30)
1471	"DATA",900 2313.91,60 ,30,0)
1472	^9002313.9 103^1^1^30 61120^
1473	"DATA",900 2313.91,60 ,30,1,0)
1474	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 10),U,6)=B PS("X")
1475	"DATA",900 2313.91,61 ,0)
1476	317^^EMPLO YER CITY A DDRESS^A/N ^^^^20^A/N
1477	"DATA",900 2313.91,61 ,5)
1478	CH^20
1479	"DATA",900 2313.91,61 ,10,0)
1480	^9002313.9 101^1^1^31 50112^
1481	"DATA",900 2313.91,61 ,10,1,0)
1482	S BPS("X") =$G(BPS("E mployer"," City"))
1483	"DATA",900 2313.91,61 ,20,0)
1484	^9002313.9 102^1^1^31 01101
1485	"DATA",900 2313.91,61 ,20,1,0)
1486	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
1487	"DATA",900 2313.91,61 ,25,0)
1488	^9002313.9 104^1^1^30 30718^^
1489	"DATA",900 2313.91,61 ,25,1,0)
1490	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),20)
1491	"DATA",900 2313.91,61 ,30,0)
1492	^9002313.9 103^1^1^30 61120^
1493	"DATA",900 2313.91,61 ,30,1,0)
1494	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 10),U,7)=B PS("X")
1495	"DATA",900 2313.91,62 ,0)
1496	318^^EMPLO YER STATE/ PROV ADDRE SS^A/N^^^^ 2^A/N
1497	"DATA",900 2313.91,62 ,1)
1498	EMPLOYER S TATE/ PROV INCE ADDRE SS
1499	"DATA",900 2313.91,62 ,5)
1500	CI^2
1501	"DATA",900 2313.91,62 ,10,0)
1502	^9002313.9 101^1^1^30 30718
1503	"DATA",900 2313.91,62 ,10,1,0)
1504	S BPS("X") =$G(BPS("E mployer"," State"))
1505	"DATA",900 2313.91,62 ,20,0)
1506	^9002313.9 102^1^1^31 01101
1507	"DATA",900 2313.91,62 ,20,1,0)
1508	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1509	"DATA",900 2313.91,62 ,25,0)
1510	^9002313.9 104^1^1^30 61121^
1511	"DATA",900 2313.91,62 ,25,1,0)
1512	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),2)
1513	"DATA",900 2313.91,62 ,30,0)
1514	^9002313.9 103^1^1^30 61120^
1515	"DATA",900 2313.91,62 ,30,1,0)
1516	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 10),U,8)=B PS("X")
1517	"DATA",900 2313.91,63 ,0)
1518	319^^EMPLO YER ZIP/PO STAL ZONE^ A/N^^^^15^ A/N
1519	"DATA",900 2313.91,63 ,5)
1520	CJ^15
1521	"DATA",900 2313.91,63 ,10,0)
1522	^9002313.9 101^1^1^30 30718
1523	"DATA",900 2313.91,63 ,10,1,0)
1524	S BPS("X") =$G(BPS("E mployer"," Zip Code") )
1525	"DATA",900 2313.91,63 ,20,0)
1526	^9002313.9 102^1^1^31 01101
1527	"DATA",900 2313.91,63 ,20,1,0)
1528	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
1529	"DATA",900 2313.91,63 ,25,0)
1530	^9002313.9 104^1^1^30 61121^
1531	"DATA",900 2313.91,63 ,25,1,0)
1532	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),15)
1533	"DATA",900 2313.91,63 ,30,0)
1534	^9002313.9 103^1^1^30 61120^
1535	"DATA",900 2313.91,63 ,30,1,0)
1536	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 10),U,9)=B PS("X")
1537	"DATA",900 2313.91,64 ,0)
1538	327^^CARRI ER ID^A/N^ ^^^10^A/N
1539	"DATA",900 2313.91,64 ,5)
1540	CR^12
1541	"DATA",900 2313.91,64 ,10,0)
1542	^9002313.9 101^1^1^30 40224
1543	"DATA",900 2313.91,64 ,10,1,0)
1544	S BPS("X") =$G(BPS("C arrier ID #"))
1545	"DATA",900 2313.91,64 ,20,0)
1546	^9002313.9 102^1^1^31 01101
1547	"DATA",900 2313.91,64 ,20,1,0)
1548	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0)
1549	"DATA",900 2313.91,64 ,25,0)
1550	^9002313.9 104^1^1^30 61121^
1551	"DATA",900 2313.91,64 ,25,1,0)
1552	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),12)
1553	"DATA",900 2313.91,64 ,30,0)
1554	^9002313.9 103^1^1^30 61120^
1555	"DATA",900 2313.91,64 ,30,1,0)
1556	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 20),U,7)=B PS("X")
1557	"DATA",900 2313.91,65 ,0)
1558	B92^^DAYS SUPPLY LIM IT TIME PE RIOD^^^^^5 ^N
1559	"DATA",900 2313.91,65 ,1)
1560	DAYS SUPPL Y LIMIT TI ME PERIOD
1561	"DATA",900 2313.91,65 ,5)
1562	3X^^2092
1563	"DATA",900 2313.91,65 ,10,0)
1564	^^1^1^3150 915^
1565	"DATA",900 2313.91,65 ,10,1,0)
1566	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
1567	"DATA",900 2313.91,66 ,0)
1568	C01^^ORIG MANUFACTUR ER PRODUCT ID^A/N^^^ ^19^A/N
1569	"DATA",900 2313.91,66 ,1)
1570	ORIGINAL M ANUFACTURE R PRODUCT ID
1571	"DATA",900 2313.91,66 ,5)
1572	4N^19^2101
1573	"DATA",900 2313.91,66 ,10,0)
1574	^9002313.9 101^1^1^31 70228^^
1575	"DATA",900 2313.91,66 ,10,1,0)
1576	S BPS("X") =""
1577	"DATA",900 2313.91,66 ,20,0)
1578	^^1^1^3170 228^
1579	"DATA",900 2313.91,66 ,20,1,0)
1580	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 9)
1581	"DATA",900 2313.91,66 ,25,0)
1582	^9002313.9 104^1^1^31 70228^^
1583	"DATA",900 2313.91,66 ,25,1,0)
1584	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 9)
1585	"DATA",900 2313.91,66 ,30,0)
1586	^^1^1^3170 228^
1587	"DATA",900 2313.91,66 ,30,1,0)
1588	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," C0"),U,1)= BPS("X")
1589	"DATA",900 2313.91,67 ,0)
1590	427^^PRESC RIBER LAST NAME^A/N^ ^^^15^A/N
1591	"DATA",900 2313.91,67 ,5)
1592	DR^15
1593	"DATA",900 2313.91,67 ,10,0)
1594	^9002313.9 101^1^1^31 10107^^
1595	"DATA",900 2313.91,67 ,10,1,0)
1596	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Prescrib er Last Na me"))
1597	"DATA",900 2313.91,67 ,20,0)
1598	^9002313.9 102^1^1^31 10107^
1599	"DATA",900 2313.91,67 ,20,1,0)
1600	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
1601	"DATA",900 2313.91,67 ,25,0)
1602	^9002313.9 104^1^1^31 10107^^
1603	"DATA",900 2313.91,67 ,25,1,0)
1604	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),15)
1605	"DATA",900 2313.91,67 ,30,0)
1606	^9002313.9 103^1^1^31 10107^^^^
1607	"DATA",900 2313.91,67 ,30,1,0)
1608	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 20),U,27)= BPS("X")
1609	"DATA",900 2313.91,68 ,0)
1610	C02^^ORIG MANUFACTUR ER PROD ID QUAL^A/N^ ^^^2^A/N
1611	"DATA",900 2313.91,68 ,1)
1612	ORIGINAL M ANUFACTURE R PRODUCT ID QUALIFI ER
1613	"DATA",900 2313.91,68 ,5)
1614	4P^2^2102
1615	"DATA",900 2313.91,68 ,10,0)
1616	^^1^1^3170 228^
1617	"DATA",900 2313.91,68 ,10,1,0)
1618	S BPS("X") =""
1619	"DATA",900 2313.91,68 ,20,0)
1620	^^1^1^3170 228^
1621	"DATA",900 2313.91,68 ,20,1,0)
1622	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1623	"DATA",900 2313.91,68 ,25,0)
1624	^^1^1^3170 228^
1625	"DATA",900 2313.91,68 ,25,1,0)
1626	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1627	"DATA",900 2313.91,68 ,30,0)
1628	^^1^1^3170 228^
1629	"DATA",900 2313.91,68 ,30,1,0)
1630	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," C0"),U,2)= BPS("X")
1631	"DATA",900 2313.91,69 ,0)
1632	434^^DATE OF INJURY^ N^^^^8^N
1633	"DATA",900 2313.91,69 ,5)
1634	DY^8
1635	"DATA",900 2313.91,69 ,10,0)
1636	^9002313.9 101^2^2^31 01115^
1637	"DATA",900 2313.91,69 ,10,1,0)
1638	S BPS("X") =$G(BPS("D ate of Inj ury"))
1639	"DATA",900 2313.91,69 ,10,2,0)
1640	S BPS("X") =$$DTF1^BP SECFM(BPS( "X"))
1641	"DATA",900 2313.91,69 ,20,0)
1642	^9002313.9 102^1^1^31 01101
1643	"DATA",900 2313.91,69 ,20,1,0)
1644	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
1645	"DATA",900 2313.91,69 ,25,0)
1646	^9002313.9 104^1^1^30 31210^^
1647	"DATA",900 2313.91,69 ,25,1,0)
1648	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
1649	"DATA",900 2313.91,69 ,30,0)
1650	^9002313.9 103^1^1^30 10125^^
1651	"DATA",900 2313.91,69 ,30,1,0)
1652	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,34)= BPS("X")
1653	"DATA",900 2313.91,70 ,0)
1654	435^^CLAIM /REFERENCE ID^A/N^^^ ^30^A/N
1655	"DATA",900 2313.91,70 ,5)
1656	DZ^30
1657	"DATA",900 2313.91,70 ,10,0)
1658	^9002313.9 101^1^1^30 30718
1659	"DATA",900 2313.91,70 ,10,1,0)
1660	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Claim/Re f ID #"))
1661	"DATA",900 2313.91,70 ,20,0)
1662	^9002313.9 102^1^1^31 01101
1663	"DATA",900 2313.91,70 ,20,1,0)
1664	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
1665	"DATA",900 2313.91,70 ,25,0)
1666	^9002313.9 104^1^1^30 61122^
1667	"DATA",900 2313.91,70 ,25,1,0)
1668	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),30)
1669	"DATA",900 2313.91,70 ,30,0)
1670	^9002313.9 103^1^1^30 30718^^^^
1671	"DATA",900 2313.91,70 ,30,1,0)
1672	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 00),U,35)= BPS("X")
1673	"DATA",900 2313.91,71 ,0)
1674	436^^PRODU CT/SERVICE ID QUALIF IER^A/N^^^ ^2^A/N
1675	"DATA",900 2313.91,71 ,5)
1676	E1^2
1677	"DATA",900 2313.91,71 ,10,0)
1678	^^1^1^3121 128
1679	"DATA",900 2313.91,71 ,10,1,0)
1680	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Product ID Qualifi er"))
1681	"DATA",900 2313.91,71 ,20,0)
1682	^9002313.9 102^1^1^31 01101
1683	"DATA",900 2313.91,71 ,20,1,0)
1684	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1685	"DATA",900 2313.91,71 ,25,0)
1686	^9002313.9 104^1^1^30 61122^
1687	"DATA",900 2313.91,71 ,25,1,0)
1688	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),2)
1689	"DATA",900 2313.91,71 ,30,0)
1690	^9002313.9 103^1^1^30 40107^^^^
1691	"DATA",900 2313.91,71 ,30,1,0)
1692	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 30),U,6)=B PS("X")
1693	"DATA",900 2313.91,72 ,0)
1694	B96^^PROVI DER FIRST NAME^A/N^^ ^^35^A/N
1695	"DATA",900 2313.91,72 ,1)
1696	PROVIDER F IRST NAME
1697	"DATA",900 2313.91,72 ,5)
1698	4A^35^2096
1699	"DATA",900 2313.91,72 ,10,0)
1700	^^1^1^3170 228^
1701	"DATA",900 2313.91,72 ,10,1,0)
1702	S BPS("X") =""
1703	"DATA",900 2313.91,72 ,20,0)
1704	^^1^1^3170 228^
1705	"DATA",900 2313.91,72 ,20,1,0)
1706	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 5)
1707	"DATA",900 2313.91,72 ,25,0)
1708	^^1^1^3170 228^
1709	"DATA",900 2313.91,72 ,25,1,0)
1710	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 5)
1711	"DATA",900 2313.91,72 ,30,0)
1712	^^1^1^3170 306^
1713	"DATA",900 2313.91,72 ,30,1,0)
1714	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B90"),U,6) =BPS("X")
1715	"DATA",900 2313.91,73 ,0)
1716	B97^^PROVI DER LAST N AME^A/N^^^ ^35^A/N
1717	"DATA",900 2313.91,73 ,1)
1718	PROVIDER L AST NAME
1719	"DATA",900 2313.91,73 ,5)
1720	4M^35^2097
1721	"DATA",900 2313.91,73 ,10,0)
1722	^^1^1^3170 228^
1723	"DATA",900 2313.91,73 ,10,1,0)
1724	S BPS("X") =""
1725	"DATA",900 2313.91,73 ,20,0)
1726	^^1^1^3170 228^
1727	"DATA",900 2313.91,73 ,20,1,0)
1728	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 5)
1729	"DATA",900 2313.91,73 ,25,0)
1730	^^1^1^3170 228^
1731	"DATA",900 2313.91,73 ,25,1,0)
1732	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 5)
1733	"DATA",900 2313.91,73 ,30,0)
1734	^^1^1^3170 306^
1735	"DATA",900 2313.91,73 ,30,1,0)
1736	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B90"),U,7) =BPS("X")
1737	"DATA",900 2313.91,74 ,0)
1738	498.51^^PR IOR AUTH P ROCESSED D ATE^A/N^^^ ^8^N
1739	"DATA",900 2313.91,74 ,5)
1740	PR^8
1741	"DATA",900 2313.91,74 ,10,0)
1742	^9002313.9 101^1^1^30 40223
1743	"DATA",900 2313.91,74 ,10,1,0)
1744	S BPS("X") =""
1745	"DATA",900 2313.91,74 ,20,0)
1746	^9002313.9 102^1^1^31 01101
1747	"DATA",900 2313.91,74 ,20,1,0)
1748	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
1749	"DATA",900 2313.91,75 ,0)
1750	202^^SERV PROVIDER I D QUALIFIE R^A/N^^^^2 ^A/N
1751	"DATA",900 2313.91,75 ,1)
1752	SERVICE PR OVIDER ID QUALIFIER
1753	"DATA",900 2313.91,75 ,5)
1754	B2^2
1755	"DATA",900 2313.91,75 ,10,0)
1756	^9002313.9 101^1^1^30 70214
1757	"DATA",900 2313.91,75 ,10,1,0)
1758	S BPS("X") ="01"
1759	"DATA",900 2313.91,75 ,20,0)
1760	^9002313.9 102^1^1^31 01101
1761	"DATA",900 2313.91,75 ,20,1,0)
1762	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1763	"DATA",900 2313.91,75 ,25,0)
1764	^9002313.9 104^1^1^30 70214^
1765	"DATA",900 2313.91,75 ,25,1,0)
1766	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1767	"DATA",900 2313.91,75 ,30,0)
1768	^9002313.9 103^1^1^30 40114^^^^
1769	"DATA",900 2313.91,75 ,30,1,0)
1770	S $P(^BPSC (BPS(90023 13.02),200 ),U,2)=BPS ("X") ;VA
1771	"DATA",900 2313.91,76 ,0)
1772	110^^SOFTW ARE VENDOR /CERT ID^A /N^^^^10^A /N
1773	"DATA",900 2313.91,76 ,1)
1774	SOFTWARE V ENDOR/ CER TIFICATION ID
1775	"DATA",900 2313.91,76 ,5)
1776	AK^10
1777	"DATA",900 2313.91,76 ,10,0)
1778	^9002313.9 101^1^1^30 61023
1779	"DATA",900 2313.91,76 ,10,1,0)
1780	S BPS("X") =$G(BPS("N CPDP","Sof tware Vend or/Cert ID "))
1781	"DATA",900 2313.91,76 ,20,0)
1782	^9002313.9 102^1^1^31 01101
1783	"DATA",900 2313.91,76 ,20,1,0)
1784	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0)
1785	"DATA",900 2313.91,76 ,25,0)
1786	^9002313.9 104^1^1^30 40202^^^^
1787	"DATA",900 2313.91,76 ,25,1,0)
1788	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0) ;VA
1789	"DATA",900 2313.91,76 ,30,0)
1790	^9002313.9 103^1^1^30 61023^
1791	"DATA",900 2313.91,76 ,30,1,0)
1792	S $P(^BPSC (BPS(90023 13.02),100 ),U,10)=BP S("X")
1793	"DATA",900 2313.91,77 ,0)
1794	331^^PATIE NT ID QUAL IFIER^A/N^ ^^^2^A/N
1795	"DATA",900 2313.91,77 ,5)
1796	CX^2
1797	"DATA",900 2313.91,77 ,10,0)
1798	^9002313.9 101^1^1^30 61023
1799	"DATA",900 2313.91,77 ,10,1,0)
1800	S BPS("X") ="01"
1801	"DATA",900 2313.91,77 ,20,0)
1802	^9002313.9 102^1^1^31 01101
1803	"DATA",900 2313.91,77 ,20,1,0)
1804	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1805	"DATA",900 2313.91,77 ,25,0)
1806	^9002313.9 104^1^1^30 30718^^
1807	"DATA",900 2313.91,77 ,25,1,0)
1808	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1809	"DATA",900 2313.91,77 ,30,0)
1810	^9002313.9 103^1^1^30 30718^^^^
1811	"DATA",900 2313.91,77 ,30,1,0)
1812	S $P(^BPSC (BPS(90023 13.02),330 ),U,1)=BPS ("X") ;VA
1813	"DATA",900 2313.91,78 ,0)
1814	332^^PATIE NT ID^A/N^ ^^^20^A/N
1815	"DATA",900 2313.91,78 ,5)
1816	CY^20
1817	"DATA",900 2313.91,78 ,10,0)
1818	^9002313.9 101^1^1^30 61023
1819	"DATA",900 2313.91,78 ,10,1,0)
1820	S BPS("X") =$G(BPS("P atient","S SN"))
1821	"DATA",900 2313.91,78 ,20,0)
1822	^9002313.9 102^1^1^31 01101
1823	"DATA",900 2313.91,78 ,20,1,0)
1824	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
1825	"DATA",900 2313.91,78 ,25,0)
1826	^9002313.9 104^1^1^30 61121^
1827	"DATA",900 2313.91,78 ,25,1,0)
1828	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
1829	"DATA",900 2313.91,78 ,30,0)
1830	^9002313.9 103^1^1^30 40820^^^^
1831	"DATA",900 2313.91,78 ,30,1,0)
1832	S $P(^BPSC (BPS(90023 13.02),330 ),U,2)=BPS ("X") ;VA
1833	"DATA",900 2313.91,79 ,0)
1834	326^^PATIE NT TELEPHO NE NUMBER^ N^^^^10^N
1835	"DATA",900 2313.91,79 ,5)
1836	CQ^10
1837	"DATA",900 2313.91,79 ,10,0)
1838	^9002313.9 101^1^1^31 01115^
1839	"DATA",900 2313.91,79 ,10,1,0)
1840	S BPS("X") =$TR($G(BP S("Patient ","Phone # ")),"#() - _*.@")
1841	"DATA",900 2313.91,79 ,20,0)
1842	^9002313.9 102^1^1^31 01101
1843	"DATA",900 2313.91,79 ,20,1,0)
1844	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
1845	"DATA",900 2313.91,79 ,25,0)
1846	^9002313.9 104^1^1^31 01115^
1847	"DATA",900 2313.91,79 ,25,1,0)
1848	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
1849	"DATA",900 2313.91,79 ,30,0)
1850	^9002313.9 103^1^1^31 01115^
1851	"DATA",900 2313.91,79 ,30,1,0)
1852	S $P(^BPSC (BPS(90023 13.02),321 ),U,6)=BPS ("X")
1853	"DATA",900 2313.91,80 ,0)
1854	455^^PRESC RIPTION/SE RV REF NO QLFR^A/N^^ ^^1^A/N
1855	"DATA",900 2313.91,80 ,1)
1856	PRESCRIPTI ON/ SERVIC E REFERENC E NUMBER Q UALIFIER
1857	"DATA",900 2313.91,80 ,5)
1858	EM^1
1859	"DATA",900 2313.91,80 ,10,0)
1860	^9002313.9 101^1^1^31 01008^
1861	"DATA",900 2313.91,80 ,10,1,0)
1862	S BPS("X") =1
1863	"DATA",900 2313.91,80 ,20,0)
1864	^9002313.9 102^1^1^31 01007^^
1865	"DATA",900 2313.91,80 ,20,1,0)
1866	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
1867	"DATA",900 2313.91,80 ,25,0)
1868	^9002313.9 104^1^1^31 01007^^^
1869	"DATA",900 2313.91,80 ,25,1,0)
1870	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
1871	"DATA",900 2313.91,80 ,30,0)
1872	^9002313.9 103^1^1^31 01007^^^^
1873	"DATA",900 2313.91,80 ,30,1,0)
1874	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 50),U,5)=B PS("X")
1875	"DATA",900 2313.91,81 ,0)
1876	460^^QUANT ITY PRESCR IBED^N^^^^ 10^N
1877	"DATA",900 2313.91,81 ,5)
1878	ET^10
1879	"DATA",900 2313.91,81 ,10,0)
1880	^9002313.9 101^1^1^31 01115^
1881	"DATA",900 2313.91,81 ,10,1,0)
1882	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Quantity "))*1000\1
1883	"DATA",900 2313.91,81 ,20,0)
1884	^9002313.9 102^1^1^31 01101
1885	"DATA",900 2313.91,81 ,20,1,0)
1886	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
1887	"DATA",900 2313.91,81 ,25,0)
1888	^9002313.9 104^1^1^30 30827^^^^
1889	"DATA",900 2313.91,81 ,25,1,0)
1890	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
1891	"DATA",900 2313.91,81 ,30,0)
1892	^9002313.9 103^1^1^31 01115^
1893	"DATA",900 2313.91,81 ,30,1,0)
1894	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 50),U,10)= BPS("X")
1895	"DATA",900 2313.91,82 ,0)
1896	465^^PROVI DER ID QUA LIFIER^A/N ^^^^2^A/N
1897	"DATA",900 2313.91,82 ,5)
1898	EY^2
1899	"DATA",900 2313.91,82 ,10,0)
1900	^9002313.9 101^1^1^30 70214
1901	"DATA",900 2313.91,82 ,10,1,0)
1902	S BPS("X") ="05"
1903	"DATA",900 2313.91,82 ,20,0)
1904	^9002313.9 102^1^1^31 01101
1905	"DATA",900 2313.91,82 ,20,1,0)
1906	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1907	"DATA",900 2313.91,82 ,25,0)
1908	^9002313.9 104^1^1^30 70214^
1909	"DATA",900 2313.91,82 ,25,1,0)
1910	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1911	"DATA",900 2313.91,82 ,30,0)
1912	^9002313.9 103^1^1^30 41015^
1913	"DATA",900 2313.91,82 ,30,1,0)
1914	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 60),U,5)=" "
1915	"DATA",900 2313.91,83 ,0)
1916	444^^PROVI DER ID^A/N ^^^^15^A/N
1917	"DATA",900 2313.91,83 ,5)
1918	E9^15
1919	"DATA",900 2313.91,83 ,10,0)
1920	^9002313.9 101^1^1^30 70214
1921	"DATA",900 2313.91,83 ,10,1,0)
1922	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Provider NPI"))
1923	"DATA",900 2313.91,83 ,20,0)
1924	^9002313.9 102^1^1^31 01101
1925	"DATA",900 2313.91,83 ,20,1,0)
1926	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
1927	"DATA",900 2313.91,83 ,25,0)
1928	^9002313.9 104^1^1^30 70214^
1929	"DATA",900 2313.91,83 ,25,1,0)
1930	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
1931	"DATA",900 2313.91,83 ,30,0)
1932	^9002313.9 103^1^1^30 41015^
1933	"DATA",900 2313.91,83 ,30,1,0)
1934	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 40),U,4)=" "
1935	"DATA",900 2313.91,84 ,0)
1936	466^^PRESC RIBER ID Q UALIFIER^A /N^^^^2^A/ N
1937	"DATA",900 2313.91,84 ,5)
1938	EZ^2
1939	"DATA",900 2313.91,84 ,10,0)
1940	^^2^2^3101 216^
1941	"DATA",900 2313.91,84 ,10,1,0)
1942	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Prescrib er ID Qual ifier"))
1943	"DATA",900 2313.91,84 ,10,2,0)
1944	S:BPS("X") ="" BPS("X ")="01"
1945	"DATA",900 2313.91,84 ,20,0)
1946	^9002313.9 102^1^1^31 01101
1947	"DATA",900 2313.91,84 ,20,1,0)
1948	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
1949	"DATA",900 2313.91,84 ,25,0)
1950	^9002313.9 104^1^1^30 70214^^^^
1951	"DATA",900 2313.91,84 ,25,1,0)
1952	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
1953	"DATA",900 2313.91,84 ,30,0)
1954	^9002313.9 103^1^1^30 30823^^^^
1955	"DATA",900 2313.91,84 ,30,1,0)
1956	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 60),U,6)=B PS("X")
1957	"DATA",900 2313.91,85 ,0)
1958	467^^PRESC RIBER LOCA TION CODE^ A/N^^^^3^A /N
1959	"DATA",900 2313.91,85 ,5)
1960	1E^3
1961	"DATA",900 2313.91,85 ,10,0)
1962	^9002313.9 101^1^1^30 30721
1963	"DATA",900 2313.91,85 ,10,1,0)
1964	S BPS("X") =$G(BPS("R X",1,"Pres criber Bil ling Locat ion"))
1965	"DATA",900 2313.91,85 ,20,0)
1966	^9002313.9 102^1^1^31 01101
1967	"DATA",900 2313.91,85 ,20,1,0)
1968	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
1969	"DATA",900 2313.91,85 ,25,0)
1970	^9002313.9 104^1^1^30 61122^
1971	"DATA",900 2313.91,85 ,25,1,0)
1972	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
1973	"DATA",900 2313.91,85 ,30,0)
1974	^9002313.9 103^1^1^30 30721^^^^
1975	"DATA",900 2313.91,85 ,30,1,0)
1976	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 60),U,7)=B PS("X")
1977	"DATA",900 2313.91,86 ,0)
1978	498^^PRESC RIBER TELE PHONE NUMB ER^N^^^^10 ^N
1979	"DATA",900 2313.91,86 ,5)
1980	PM^10
1981	"DATA",900 2313.91,86 ,10,0)
1982	^9002313.9 101^1^1^31 01029^
1983	"DATA",900 2313.91,86 ,10,1,0)
1984	S BPS("X") =$TR($G(BP S("RX",BPS (9002313.0 201),"Pres criber Pho ne #")),"# () -_*.@")
1985	"DATA",900 2313.91,86 ,20,0)
1986	^9002313.9 102^1^1^31 01101
1987	"DATA",900 2313.91,86 ,20,1,0)
1988	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
1989	"DATA",900 2313.91,86 ,25,0)
1990	^9002313.9 104^1^1^30 61122^
1991	"DATA",900 2313.91,86 ,25,1,0)
1992	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
1993	"DATA",900 2313.91,86 ,30,0)
1994	^9002313.9 103^1^1^31 00917^^^^
1995	"DATA",900 2313.91,86 ,30,1,0)
1996	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 98),U,12)= BPS("X")
1997	"DATA",900 2313.91,87 ,0)
1998	468^^PRIMA RY CARE PR OVIDER ID QLFR^A/N^^ ^^2^A/N
1999	"DATA",900 2313.91,87 ,1)
2000	PRIMARY CA RE PROVIDE R ID QUALI FIER
2001	"DATA",900 2313.91,87 ,5)
2002	2E^2
2003	"DATA",900 2313.91,87 ,10,0)
2004	^^2^2^3110 727^
2005	"DATA",900 2313.91,87 ,10,1,0)
2006	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Primary Care Prov ID Qual"))
2007	"DATA",900 2313.91,87 ,10,2,0)
2008	S:BPS("X") ="" BPS("X ")="01"
2009	"DATA",900 2313.91,87 ,20,0)
2010	^9002313.9 102^1^1^31 01101
2011	"DATA",900 2313.91,87 ,20,1,0)
2012	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2013	"DATA",900 2313.91,87 ,25,0)
2014	^9002313.9 104^1^1^30 70214^^^^
2015	"DATA",900 2313.91,87 ,25,1,0)
2016	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
2017	"DATA",900 2313.91,87 ,30,0)
2018	^9002313.9 103^1^1^30 41015^
2019	"DATA",900 2313.91,87 ,30,1,0)
2020	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 60),U,8)=" "
2021	"DATA",900 2313.91,88 ,0)
2022	469^^PRIM CARE PROV LOCATION C ODE^N^^^^3 ^A/N
2023	"DATA",900 2313.91,88 ,5)
2024	H5^3
2025	"DATA",900 2313.91,88 ,10,0)
2026	^9002313.9 101^1^1^30 40114
2027	"DATA",900 2313.91,88 ,10,1,0)
2028	S BPS("X") =$G(BPS("P atient","P rimary Car e Prov Loc ation Code "))
2029	"DATA",900 2313.91,88 ,20,0)
2030	^9002313.9 102^1^1^31 01101
2031	"DATA",900 2313.91,88 ,20,1,0)
2032	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
2033	"DATA",900 2313.91,88 ,25,0)
2034	^9002313.9 104^1^1^30 40114^^^^
2035	"DATA",900 2313.91,88 ,25,1,0)
2036	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),3)
2037	"DATA",900 2313.91,88 ,30,0)
2038	^9002313.9 103^1^1^30 40114^^^^
2039	"DATA",900 2313.91,88 ,30,1,0)
2040	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 60),U,9)=B PS("X")
2041	"DATA",900 2313.91,89 ,0)
2042	470^^PRIM CARE PROVI DER LAST N AME^A/N^^^ ^15^A/N
2043	"DATA",900 2313.91,89 ,1)
2044	PRIMARY CA RE PROVIDE R LAST NAM E
2045	"DATA",900 2313.91,89 ,5)
2046	4E^15
2047	"DATA",900 2313.91,89 ,10,0)
2048	^^1^1^3101 217^
2049	"DATA",900 2313.91,89 ,10,1,0)
2050	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Primary Care Prov Last Name" ))
2051	"DATA",900 2313.91,89 ,20,0)
2052	^9002313.9 102^1^1^31 01101
2053	"DATA",900 2313.91,89 ,20,1,0)
2054	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
2055	"DATA",900 2313.91,89 ,25,0)
2056	^9002313.9 104^1^1^30 61122^
2057	"DATA",900 2313.91,89 ,25,1,0)
2058	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),15)
2059	"DATA",900 2313.91,89 ,30,0)
2060	^9002313.9 103^1^1^30 30825^^^^
2061	"DATA",900 2313.91,89 ,30,1,0)
2062	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 60),U,10)= BPS("X")
2063	"DATA",900 2313.91,90 ,0)
2064	B95^^FACIL ITY ID QUA LIFIER^A/N ^^^^2^A/N
2065	"DATA",900 2313.91,90 ,1)
2066	FACILITY I D QUALIFIE R
2067	"DATA",900 2313.91,90 ,5)
2068	3Z^2^2095
2069	"DATA",900 2313.91,90 ,10,0)
2070	^9002313.9 101^2^2^31 70530^^^
2071	"DATA",900 2313.91,90 ,10,1,0)
2072	S BPS("X") =$G(BPS("" Insurer"", ""Facility ID""))
2073	"DATA",900 2313.91,90 ,10,2,0)
2074	S BPS(""X" ")=$S(BPS( ""X"")'="" "":""1"",1 :"""")
2075	"DATA",900 2313.91,90 ,20,0)
2076	^9002313.9 102^1^1^31 70530^^^
2077	"DATA",900 2313.91,90 ,20,1,0)
2078	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2079	"DATA",900 2313.91,90 ,25,0)
2080	^9002313.9 104^1^1^31 70530^^^
2081	"DATA",900 2313.91,90 ,25,1,0)
2082	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2083	"DATA",900 2313.91,90 ,30,0)
2084	^9002313.9 103^1^1^31 70530^^^
2085	"DATA",900 2313.91,90 ,30,1,0)
2086	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B90"),U,1) =BPS("X")
2087	"DATA",900 2313.91,91 ,0)
2088	480^^OTHER AMT CLAIM ED SUBMITT ED^D^^^^8^ D
2089	"DATA",900 2313.91,91 ,1)
2090	OTHER AMOU NT CLAIMED SUBMITTED
2091	"DATA",900 2313.91,91 ,5)
2092	H9^8
2093	"DATA",900 2313.91,91 ,10,0)
2094	^9002313.9 101^1^1^31 01006^^^^
2095	"DATA",900 2313.91,91 ,10,1,0)
2096	; GET CODE handled b y FLD480^B PSOSSG
2097	"DATA",900 2313.91,91 ,20,0)
2098	^9002313.9 102^1^1^31 01006^^^^
2099	"DATA",900 2313.91,91 ,20,1,0)
2100	; vD.0 for mat code h andled by FLD480^BPS OSSG
2101	"DATA",900 2313.91,91 ,25,0)
2102	^9002313.9 104^1^1^31 01006^^^^
2103	"DATA",900 2313.91,91 ,25,1,0)
2104	; format c ode handle d by FLD48 0^BPSOSSG
2105	"DATA",900 2313.91,91 ,30,0)
2106	^9002313.9 103^1^1^31 01006^^^^
2107	"DATA",900 2313.91,91 ,30,1,0)
2108	D FLD480^B PSOSSG
2109	"DATA",900 2313.91,92 ,0)
2110	109^^TRANS ACTION COU NT^A/N^^^^ 1^A/N
2111	"DATA",900 2313.91,92 ,5)
2112	A9^1
2113	"DATA",900 2313.91,92 ,10,0)
2114	^9002313.9 101^1^1^31 01115^
2115	"DATA",900 2313.91,92 ,10,1,0)
2116	S BPS("X") =$G(BPS("T ransaction Count"))
2117	"DATA",900 2313.91,92 ,20,0)
2118	^9002313.9 102^1^1^31 01101
2119	"DATA",900 2313.91,92 ,20,1,0)
2120	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
2121	"DATA",900 2313.91,92 ,25,0)
2122	^9002313.9 104^1^1^30 40114^^^^
2123	"DATA",900 2313.91,92 ,25,1,0)
2124	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
2125	"DATA",900 2313.91,92 ,30,0)
2126	^9002313.9 103^1^1^30 40114^^^
2127	"DATA",900 2313.91,92 ,30,1,0)
2128	S $P(^BPSC (BPS(90023 13.02),100 ),U,9)=BPS ("X")
2129	"DATA",900 2313.91,93 ,0)
2130	111^^SEGME NT IDENTIF ICATION^A/ N^^^^2^A/N
2131	"DATA",900 2313.91,93 ,5)
2132	AM^2
2133	"DATA",900 2313.91,93 ,10,0)
2134	^9002313.9 101^1^1^30 40114
2135	"DATA",900 2313.91,93 ,10,1,0)
2136	S BPS("X") =""
2137	"DATA",900 2313.91,93 ,20,0)
2138	^9002313.9 102^1^1^31 01101
2139	"DATA",900 2313.91,93 ,20,1,0)
2140	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2141	"DATA",900 2313.91,94 ,0)
2142	B98^^RECON CILIATION ID^A/N^^^^ 30^A/N
2143	"DATA",900 2313.91,94 ,1)
2144	RECONCILIA TION ID
2145	"DATA",900 2313.91,94 ,5)
2146	34^30^2098
2147	"DATA",900 2313.91,94 ,10,0)
2148	^9002313.9 101^2^2^31 70530^^^
2149	"DATA",900 2313.91,94 ,10,1,0)
2150	"; THIS IS A RESPONS E-ONLY FIE LD WHICH D OES NOT US E THE GET, FORMAT, O R
2151	"DATA",900 2313.91,94 ,10,2,0)
2152	SET CODE"
2153	"DATA",900 2313.91,95 ,0)
2154	112^^TRANS ACTION RES PONSE STAT US^A/N^^^^ 1^A/N
2155	"DATA",900 2313.91,95 ,5)
2156	AN^2
2157	"DATA",900 2313.91,95 ,10,0)
2158	^9002313.9 101^1^1^31 01115^^
2159	"DATA",900 2313.91,95 ,10,1,0)
2160	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
2161	"DATA",900 2313.91,95 ,25,0)
2162	^9002313.9 104^1^1^30 40114^^
2163	"DATA",900 2313.91,95 ,25,1,0)
2164	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
2165	"DATA",900 2313.91,95 ,30,0)
2166	^9002313.9 103^1^1^30 40114^^
2167	"DATA",900 2313.91,95 ,30,1,0)
2168	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 110),U,2)= BPS("X")
2169	"DATA",900 2313.91,96 ,0)
2170	320^^EMPLO YER TELEPH ONE NUMBER ^N^^^^10^N
2171	"DATA",900 2313.91,96 ,5)
2172	CK^10
2173	"DATA",900 2313.91,96 ,10,0)
2174	^9002313.9 101^1^1^30 50802
2175	"DATA",900 2313.91,96 ,10,1,0)
2176	S BPS("X") =$TR($G(BP S("Employe r","Phone" )),"#() -_ *.@")
2177	"DATA",900 2313.91,96 ,20,0)
2178	^9002313.9 102^1^1^31 01101
2179	"DATA",900 2313.91,96 ,20,1,0)
2180	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
2181	"DATA",900 2313.91,96 ,25,0)
2182	^9002313.9 104^1^1^30 61121^
2183	"DATA",900 2313.91,96 ,25,1,0)
2184	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),10)
2185	"DATA",900 2313.91,96 ,30,0)
2186	^9002313.9 103^1^1^30 61120^
2187	"DATA",900 2313.91,96 ,30,1,0)
2188	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 10),U,10)= BPS("X")
2189	"DATA",900 2313.91,97 ,0)
2190	321^^EMPLO YER CONTAC T NAME^A/N ^^^^30^A/N
2191	"DATA",900 2313.91,97 ,5)
2192	CL^30
2193	"DATA",900 2313.91,97 ,10,0)
2194	^9002313.9 101^1^1^30 40224
2195	"DATA",900 2313.91,97 ,10,1,0)
2196	S BPS("X") =""
2197	"DATA",900 2313.91,97 ,20,0)
2198	^9002313.9 102^1^1^31 01101
2199	"DATA",900 2313.91,97 ,20,1,0)
2200	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
2201	"DATA",900 2313.91,97 ,25,0)
2202	^9002313.9 104^1^1^30 40224^^^
2203	"DATA",900 2313.91,97 ,25,1,0)
2204	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),30)
2205	"DATA",900 2313.91,97 ,30,0)
2206	^9002313.9 103^1^1^30 40224^
2207	"DATA",900 2313.91,97 ,30,1,0)
2208	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 20),U,1)=B PS("X")
2209	"DATA",900 2313.91,98 ,0)
2210	330^^ALTER NATE ID^A/ N^^^^20^A/ N
2211	"DATA",900 2313.91,98 ,5)
2212	CW^20
2213	"DATA",900 2313.91,98 ,10,0)
2214	^9002313.9 101^1^1^30 40224
2215	"DATA",900 2313.91,98 ,10,1,0)
2216	S BPS("X") =""
2217	"DATA",900 2313.91,98 ,20,0)
2218	^9002313.9 102^1^1^31 01101
2219	"DATA",900 2313.91,98 ,20,1,0)
2220	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
2221	"DATA",900 2313.91,98 ,25,0)
2222	^9002313.9 104^1^1^30 40224^^^
2223	"DATA",900 2313.91,98 ,25,1,0)
2224	S BPS("X") =$$NFF^BPS ECFM(BPS(" X"),20)
2225	"DATA",900 2313.91,98 ,30,0)
2226	^9002313.9 103^1^1^30 40224^^
2227	"DATA",900 2313.91,98 ,30,1,0)
2228	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 20),U,10)= BPS("X")
2229	"DATA",900 2313.91,99 ,0)
2230	333^^EMPLO YER ID^A/N ^^^^15^A/N
2231	"DATA",900 2313.91,99 ,5)
2232	CZ^15
2233	"DATA",900 2313.91,99 ,10,0)
2234	^9002313.9 101^1^1^30 30823
2235	"DATA",900 2313.91,99 ,10,1,0)
2236	S BPS("X") =""
2237	"DATA",900 2313.91,99 ,20,0)
2238	^9002313.9 102^1^1^31 01101
2239	"DATA",900 2313.91,99 ,20,1,0)
2240	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
2241	"DATA",900 2313.91,99 ,25,0)
2242	^9002313.9 104^1^1^30 30823^
2243	"DATA",900 2313.91,99 ,25,1,0)
2244	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
2245	"DATA",900 2313.91,99 ,30,0)
2246	^9002313.9 103^1^1^30 30823^^^^
2247	"DATA",900 2313.91,99 ,30,1,0)
2248	S $P(^BPSC (BPS(90023 13.02),330 ),U,3)=BPS ("X")
2249	"DATA",900 2313.91,10 0,0)
2250	334^^SMOKE R/NONSMOKE R^N^^^^1^A /N
2251	"DATA",900 2313.91,10 0,5)
2252	1C^1
2253	"DATA",900 2313.91,10 0,10,0)
2254	^9002313.9 101^1^1^30 70620
2255	"DATA",900 2313.91,10 0,10,1,0)
2256	S BPS("X") =""
2257	"DATA",900 2313.91,10 0,20,0)
2258	^9002313.9 102^1^1^31 01101
2259	"DATA",900 2313.91,10 0,20,1,0)
2260	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
2261	"DATA",900 2313.91,10 0,25,0)
2262	^9002313.9 104^1^1^30 40114^^^^
2263	"DATA",900 2313.91,10 0,25,1,0)
2264	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),1)
2265	"DATA",900 2313.91,10 0,30,0)
2266	^9002313.9 103^1^1^30 40114^^^^
2267	"DATA",900 2313.91,10 0,30,1,0)
2268	S $P(^BPSC (BPS(90023 13.02),330 ),U,4)=BPS ("X")
2269	"DATA",900 2313.91,10 1,0)
2270	335^^PREGN ANCY INDIC ATOR^N^^^^ 1^A/N
2271	"DATA",900 2313.91,10 1,5)
2272	2C^1
2273	"DATA",900 2313.91,10 1,10,0)
2274	^9002313.9 101^1^1^30 30823
2275	"DATA",900 2313.91,10 1,10,1,0)
2276	S BPS("X") =""
2277	"DATA",900 2313.91,10 1,20,0)
2278	^9002313.9 102^1^1^31 01101
2279	"DATA",900 2313.91,10 1,20,1,0)
2280	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
2281	"DATA",900 2313.91,10 1,25,0)
2282	^9002313.9 104^1^1^30 30823^^
2283	"DATA",900 2313.91,10 1,25,1,0)
2284	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),1)
2285	"DATA",900 2313.91,10 1,30,0)
2286	^9002313.9 103^1^1^30 30823^^
2287	"DATA",900 2313.91,10 1,30,1,0)
2288	S $P(^BPSC (BPS(90023 13.02),330 ),U,5)=BPS ("X")
2289	"DATA",900 2313.91,10 2,0)
2290	336^^FACIL ITY ID^A/N ^^^^10^A/N
2291	"DATA",900 2313.91,10 2,5)
2292	8C^10
2293	"DATA",900 2313.91,10 2,10,0)
2294	^9002313.9 101^1^1^30 70103
2295	"DATA",900 2313.91,10 2,10,1,0)
2296	S BPS("X") =$G(BPS("I nsurer","F acility ID "))
2297	"DATA",900 2313.91,10 2,20,0)
2298	^9002313.9 102^1^1^31 01101
2299	"DATA",900 2313.91,10 2,20,1,0)
2300	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0)
2301	"DATA",900 2313.91,10 2,25,0)
2302	^9002313.9 104^1^1^30 30823^^
2303	"DATA",900 2313.91,10 2,25,1,0)
2304	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),10)
2305	"DATA",900 2313.91,10 2,30,0)
2306	^9002313.9 103^1^1^30 30823^
2307	"DATA",900 2313.91,10 2,30,1,0)
2308	S $P(^BPSC (BPS(90023 13.02),330 ),U,6)=BPS ("X")
2309	"DATA",900 2313.91,10 3,0)
2310	337^^COB/O THER PAYME NTS COUNT^ N^^^^1^N
2311	"DATA",900 2313.91,10 3,1)
2312	COORDINATI ON OF BENE FITS/OTHER PAYMENTS COUNT
2313	"DATA",900 2313.91,10 3,5)
2314	4C^1
2315	"DATA",900 2313.91,10 3,10,0)
2316	^9002313.9 101^1^1^31 00916
2317	"DATA",900 2313.91,10 3,10,1,0)
2318	;GET code for this C OB field i s executed in COB^BP SOSHF
2319	"DATA",900 2313.91,10 3,20,0)
2320	^9002313.9 102^1^1^31 01101
2321	"DATA",900 2313.91,10 3,20,1,0)
2322	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
2323	"DATA",900 2313.91,10 3,25,0)
2324	^9002313.9 104^1^1^30 40223^^^
2325	"DATA",900 2313.91,10 3,25,1,0)
2326	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
2327	"DATA",900 2313.91,10 3,30,0)
2328	^9002313.9 103^1^1^31 00824
2329	"DATA",900 2313.91,10 3,30,1,0)
2330	D SET337^B PSFLD01
2331	"DATA",900 2313.91,10 4,0)
2332	338^^OTHER PAYER COV ERAGE TYPE ^N^^^^2^A/ N
2333	"DATA",900 2313.91,10 4,5)
2334	5C^2
2335	"DATA",900 2313.91,10 4,10,0)
2336	^9002313.9 101^1^1^31 00916
2337	"DATA",900 2313.91,10 4,10,1,0)
2338	;GET code for this C OB field i s executed in COB^BP SOSHF
2339	"DATA",900 2313.91,10 4,20,0)
2340	^9002313.9 102^1^1^31 01101
2341	"DATA",900 2313.91,10 4,20,1,0)
2342	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2343	"DATA",900 2313.91,10 4,25,0)
2344	^9002313.9 104^1^1^31 01029^
2345	"DATA",900 2313.91,10 4,25,1,0)
2346	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2347	"DATA",900 2313.91,10 4,30,0)
2348	^9002313.9 103^1^1^31 01004^
2349	"DATA",900 2313.91,10 4,30,1,0)
2350	D SET338^B PSFLD01
2351	"DATA",900 2313.91,10 5,0)
2352	339^^OTHER PAYER ID QUALIFIER^ N^^^^2^A/N
2353	"DATA",900 2313.91,10 5,5)
2354	6C^2
2355	"DATA",900 2313.91,10 5,10,0)
2356	^9002313.9 101^1^1^31 00916
2357	"DATA",900 2313.91,10 5,10,1,0)
2358	;GET code for this C OB field i s executed in COB^BP SOSHF
2359	"DATA",900 2313.91,10 5,20,0)
2360	^9002313.9 102^1^1^31 01101
2361	"DATA",900 2313.91,10 5,20,1,0)
2362	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2363	"DATA",900 2313.91,10 5,25,0)
2364	^9002313.9 104^1^1^31 01029^
2365	"DATA",900 2313.91,10 5,25,1,0)
2366	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2367	"DATA",900 2313.91,10 5,30,0)
2368	^9002313.9 103^1^1^31 01004^
2369	"DATA",900 2313.91,10 5,30,1,0)
2370	D SET339^B PSFLD01
2371	"DATA",900 2313.91,10 6,0)
2372	340^^OTHER PAYER ID^ A/N^^^^10^ A/N
2373	"DATA",900 2313.91,10 6,5)
2374	7C^10
2375	"DATA",900 2313.91,10 6,10,0)
2376	^9002313.9 101^1^1^31 00916
2377	"DATA",900 2313.91,10 6,10,1,0)
2378	;GET code for this C OB field i s executed in COB^BP SOSHF
2379	"DATA",900 2313.91,10 6,20,0)
2380	^9002313.9 102^1^1^31 01101
2381	"DATA",900 2313.91,10 6,20,1,0)
2382	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0)
2383	"DATA",900 2313.91,10 6,25,0)
2384	^9002313.9 104^1^1^30 40223^^
2385	"DATA",900 2313.91,10 6,25,1,0)
2386	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0)
2387	"DATA",900 2313.91,10 6,30,0)
2388	^9002313.9 103^1^1^31 01004^^
2389	"DATA",900 2313.91,10 6,30,1,0)
2390	D SET340^B PSFLD01
2391	"DATA",900 2313.91,10 7,0)
2392	341^^OTHER PAYER AMO UNT PAID C OUNT^N^^^^ 1^N
2393	"DATA",900 2313.91,10 7,5)
2394	HB^1
2395	"DATA",900 2313.91,10 7,10,0)
2396	^9002313.9 101^1^1^31 00916
2397	"DATA",900 2313.91,10 7,10,1,0)
2398	;GET code for this C OB field i s executed in COB^BP SOSHF
2399	"DATA",900 2313.91,10 7,20,0)
2400	^9002313.9 102^1^1^31 01101
2401	"DATA",900 2313.91,10 7,20,1,0)
2402	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
2403	"DATA",900 2313.91,10 7,25,0)
2404	^9002313.9 104^1^1^30 40224^^^^
2405	"DATA",900 2313.91,10 7,25,1,0)
2406	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
2407	"DATA",900 2313.91,10 7,30,0)
2408	^9002313.9 103^1^1^31 00824
2409	"DATA",900 2313.91,10 7,30,1,0)
2410	D SET341^B PSFLD01
2411	"DATA",900 2313.91,10 8,0)
2412	342^^OTHER PAYER AMT PAID QUAL IFIER^A/N^ ^^^2^A/N
2413	"DATA",900 2313.91,10 8,1)
2414	OTHER PAYE R AMOUNT P AID QUALIF IER
2415	"DATA",900 2313.91,10 8,5)
2416	HC^2
2417	"DATA",900 2313.91,10 8,10,0)
2418	^9002313.9 101^1^1^31 00916
2419	"DATA",900 2313.91,10 8,10,1,0)
2420	;GET code for this C OB field i s executed in COB^BP SOSHF
2421	"DATA",900 2313.91,10 8,20,0)
2422	^9002313.9 102^1^1^31 01101
2423	"DATA",900 2313.91,10 8,20,1,0)
2424	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2425	"DATA",900 2313.91,10 8,25,0)
2426	^9002313.9 104^1^1^31 01029^
2427	"DATA",900 2313.91,10 8,25,1,0)
2428	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2429	"DATA",900 2313.91,10 8,30,0)
2430	^9002313.9 103^1^1^31 00824
2431	"DATA",900 2313.91,10 8,30,1,0)
2432	D SET342^B PSFLD01
2433	"DATA",900 2313.91,10 9,0)
2434	343^^DISPE NSING STAT US^A/N^^^^ 1^A/N
2435	"DATA",900 2313.91,10 9,5)
2436	HD^1
2437	"DATA",900 2313.91,10 9,10,0)
2438	^9002313.9 101^1^1^30 40913
2439	"DATA",900 2313.91,10 9,10,1,0)
2440	S BPS("X") =""
2441	"DATA",900 2313.91,10 9,20,0)
2442	^9002313.9 102^1^1^31 01101
2443	"DATA",900 2313.91,10 9,20,1,0)
2444	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
2445	"DATA",900 2313.91,10 9,25,0)
2446	^9002313.9 104^1^1^30 40913^^^^
2447	"DATA",900 2313.91,10 9,25,1,0)
2448	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
2449	"DATA",900 2313.91,10 9,30,0)
2450	^9002313.9 103^1^1^30 70620^
2451	"DATA",900 2313.91,10 9,30,1,0)
2452	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 40),U,3)=" "
2453	"DATA",900 2313.91,11 0,0)
2454	344^^QTY I NTENDED TO BE DISPEN SED^N^^^^1 0^N
2455	"DATA",900 2313.91,11 0,1)
2456	QUANTITY I NTENDED TO BE DISPEN SED
2457	"DATA",900 2313.91,11 0,5)
2458	HF^10
2459	"DATA",900 2313.91,11 0,10,0)
2460	^9002313.9 101^1^1^30 70620
2461	"DATA",900 2313.91,11 0,10,1,0)
2462	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Quantity "))*1000\1
2463	"DATA",900 2313.91,11 0,20,0)
2464	^9002313.9 102^1^1^31 01101
2465	"DATA",900 2313.91,11 0,20,1,0)
2466	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
2467	"DATA",900 2313.91,11 0,25,0)
2468	^9002313.9 104^1^1^30 70620^
2469	"DATA",900 2313.91,11 0,25,1,0)
2470	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
2471	"DATA",900 2313.91,11 0,30,0)
2472	^9002313.9 103^1^1^30 70620^
2473	"DATA",900 2313.91,11 0,30,1,0)
2474	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 40),U,4)=" "
2475	"DATA",900 2313.91,11 1,0)
2476	345^^DAYS SUPPLY INT END TO BE DISP^N^^^^ 3^N
2477	"DATA",900 2313.91,11 1,1)
2478	DAYS SUPPL Y INTENDED TO BE DIS PENSED
2479	"DATA",900 2313.91,11 1,5)
2480	HG^3
2481	"DATA",900 2313.91,11 1,10,0)
2482	^9002313.9 101^1^1^30 30827
2483	"DATA",900 2313.91,11 1,10,1,0)
2484	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Days Sup ply"))*100 0
2485	"DATA",900 2313.91,11 1,20,0)
2486	^9002313.9 102^1^1^31 01101
2487	"DATA",900 2313.91,11 1,20,1,0)
2488	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),3)
2489	"DATA",900 2313.91,11 1,25,0)
2490	^9002313.9 104^1^1^30 30827^^^
2491	"DATA",900 2313.91,11 1,25,1,0)
2492	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),3)
2493	"DATA",900 2313.91,11 1,30,0)
2494	^9002313.9 103^1^1^30 70620^
2495	"DATA",900 2313.91,11 1,30,1,0)
2496	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 40),U,5)=" "
2497	"DATA",900 2313.91,11 2,0)
2498	346^^BASIS OF CALC - DISPENSIN G FEE^A/N^ ^^^2^A/N
2499	"DATA",900 2313.91,11 2,5)
2500	HH^8
2501	"DATA",900 2313.91,11 2,10,0)
2502	^9002313.9 101^1^1^31 01115^
2503	"DATA",900 2313.91,11 2,10,1,0)
2504	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
2505	"DATA",900 2313.91,11 2,25,0)
2506	^^1^1^3031 205^
2507	"DATA",900 2313.91,11 2,25,1,0)
2508	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),8 )
2509	"DATA",900 2313.91,11 2,30,0)
2510	^^1^1^3031 205^
2511	"DATA",900 2313.91,11 2,30,1,0)
2512	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 340),U,6)= BPS("X")
2513	"DATA",900 2313.91,11 3,0)
2514	347^^BASIS OF CALC - COPAY^A/N ^^^^2^A/N
2515	"DATA",900 2313.91,11 3,5)
2516	HJ^8
2517	"DATA",900 2313.91,11 3,10,0)
2518	^9002313.9 101^1^1^31 01115^
2519	"DATA",900 2313.91,11 3,10,1,0)
2520	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
2521	"DATA",900 2313.91,11 3,25,0)
2522	^9002313.9 104^1^1^30 40114^^^
2523	"DATA",900 2313.91,11 3,25,1,0)
2524	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),8 )
2525	"DATA",900 2313.91,11 3,30,0)
2526	^9002313.9 103^1^1^30 40114^^^
2527	"DATA",900 2313.91,11 3,30,1,0)
2528	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 340),U,7)= BPS("X")
2529	"DATA",900 2313.91,11 4,0)
2530	348^^BASIS OF CALC - FLAT SALE S TAX^A/N^ ^^^2^A/N
2531	"DATA",900 2313.91,11 4,5)
2532	HK^8
2533	"DATA",900 2313.91,11 4,10,0)
2534	^9002313.9 101^1^1^31 01115^
2535	"DATA",900 2313.91,11 4,10,1,0)
2536	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
2537	"DATA",900 2313.91,11 4,25,0)
2538	^^1^1^3031 205^
2539	"DATA",900 2313.91,11 4,25,1,0)
2540	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),8 )
2541	"DATA",900 2313.91,11 4,30,0)
2542	^^1^1^3031 205^
2543	"DATA",900 2313.91,11 4,30,1,0)
2544	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 340),U,8)= BPS("X")
2545	"DATA",900 2313.91,11 5,0)
2546	349^^BASIS OF CALC - % SALES T AX^A/N^^^^ 2^A/N
2547	"DATA",900 2313.91,11 5,5)
2548	HM^8
2549	"DATA",900 2313.91,11 5,10,0)
2550	^9002313.9 101^1^1^31 01115^
2551	"DATA",900 2313.91,11 5,10,1,0)
2552	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
2553	"DATA",900 2313.91,11 5,25,0)
2554	^^1^1^3031 205^
2555	"DATA",900 2313.91,11 5,25,1,0)
2556	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),8 )
2557	"DATA",900 2313.91,11 5,30,0)
2558	^^1^1^3031 205^
2559	"DATA",900 2313.91,11 5,30,1,0)
2560	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 340),U,9)= BPS("X")
2561	"DATA",900 2313.91,11 6,0)
2562	350^^PATIE NT E-MAIL ADDRESS^A/ N^^^^80^A/ N
2563	"DATA",900 2313.91,11 6,5)
2564	HN^80
2565	"DATA",900 2313.91,11 6,10,0)
2566	^9002313.9 101^1^1^30 30512
2567	"DATA",900 2313.91,11 6,10,1,0)
2568	S BPS("X") =$G(BPS("P atient","P atient E-M ail Addres s"))
2569	"DATA",900 2313.91,11 6,20,0)
2570	^9002313.9 102^1^1^31 01101
2571	"DATA",900 2313.91,11 6,20,1,0)
2572	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),8 0)
2573	"DATA",900 2313.91,11 6,30,0)
2574	^9002313.9 103^1^1^31 01101^^^
2575	"DATA",900 2313.91,11 6,30,1,0)
2576	S $P(^BPSC (BPS(90023 13.02),340 ),U,10)=$G (BPS("X"))
2577	"DATA",900 2313.91,11 7,0)
2578	351^^OTHER PAYER-PAT RESP AMT QLFR^A/N^^ ^^2^A/N
2579	"DATA",900 2313.91,11 7,1)
2580	OTHER PAYE R-PATIENT RESPONSIBI LITY AMOUN T QUALIFIE R
2581	"DATA",900 2313.91,11 7,5)
2582	NP^1
2583	"DATA",900 2313.91,11 7,10,0)
2584	^^1^1^3101 222^
2585	"DATA",900 2313.91,11 7,10,1,0)
2586	;GET code for this C OB field i s executed in COB^BP SOSHF
2587	"DATA",900 2313.91,11 7,20,0)
2588	^9002313.9 102^1^1^31 01220^
2589	"DATA",900 2313.91,11 7,20,1,0)
2590	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2591	"DATA",900 2313.91,11 7,30,0)
2592	^^1^1^3101 222^
2593	"DATA",900 2313.91,11 7,30,1,0)
2594	D SET351^B PSFLD01
2595	"DATA",900 2313.91,11 8,0)
2596	352^^OTHER PAYER-PAT RESP AMOU NT^D^^^^10 ^D
2597	"DATA",900 2313.91,11 8,1)
2598	OTHER PAYE R-PATIENT RESPONSIBI LITY AMOUN T
2599	"DATA",900 2313.91,11 8,5)
2600	NQ^10
2601	"DATA",900 2313.91,11 8,10,0)
2602	^^1^1^3101 222^
2603	"DATA",900 2313.91,11 8,10,1,0)
2604	;GET code for this C OB field i s executed in COB^BP SOSHF
2605	"DATA",900 2313.91,11 8,20,0)
2606	^9002313.9 102^1^1^31 01101
2607	"DATA",900 2313.91,11 8,20,1,0)
2608	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),10 )
2609	"DATA",900 2313.91,11 8,25,0)
2610	^9002313.9 104^1^1^30 31212^
2611	"DATA",900 2313.91,11 8,25,1,0)
2612	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),10 )
2613	"DATA",900 2313.91,11 8,30,0)
2614	^9002313.9 103^1^1^31 01222^^
2615	"DATA",900 2313.91,11 8,30,1,0)
2616	D SET352^B PSFLD01
2617	"DATA",900 2313.91,11 9,0)
2618	353^^OTHER PAYER-PAT RESP AMT CNT^N^^^^2 ^N
2619	"DATA",900 2313.91,11 9,1)
2620	OTHER PAYE R-PATIENT RESPONSIBI LITY AMOUN T COUNT
2621	"DATA",900 2313.91,11 9,5)
2622	NR^1
2623	"DATA",900 2313.91,11 9,10,0)
2624	^^1^1^3101 222^
2625	"DATA",900 2313.91,11 9,10,1,0)
2626	;GET code for this C OB field i s executed in COB^BP SOSHF
2627	"DATA",900 2313.91,11 9,20,0)
2628	^9002313.9 102^1^1^31 01101
2629	"DATA",900 2313.91,11 9,20,1,0)
2630	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
2631	"DATA",900 2313.91,11 9,30,0)
2632	^9002313.9 103^1^1^31 01222^^
2633	"DATA",900 2313.91,11 9,30,1,0)
2634	D SET353^B PSFLD01
2635	"DATA",900 2313.91,12 0,0)
2636	445^^ORIG PRESCRIBED PROD/SERV CODE^A/N^ ^^^19^A/N
2637	"DATA",900 2313.91,12 0,1)
2638	ORIGINALLY PRESCRIBE D PRODUCT/ SERVICE CO DE
2639	"DATA",900 2313.91,12 0,5)
2640	EA^19
2641	"DATA",900 2313.91,12 0,10,0)
2642	^9002313.9 101^1^1^31 01029^
2643	"DATA",900 2313.91,12 0,10,1,0)
2644	S BPS("X") =""
2645	"DATA",900 2313.91,12 0,20,0)
2646	^9002313.9 102^1^1^31 01101
2647	"DATA",900 2313.91,12 0,20,1,0)
2648	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 9)
2649	"DATA",900 2313.91,12 0,25,0)
2650	^9002313.9 104^1^1^30 40107^^
2651	"DATA",900 2313.91,12 0,25,1,0)
2652	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),19)
2653	"DATA",900 2313.91,12 0,30,0)
2654	^9002313.9 103^1^1^31 01115^
2655	"DATA",900 2313.91,12 0,30,1,0)
2656	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 40),U,5)=" "
2657	"DATA",900 2313.91,12 1,0)
2658	446^^ORIGI NALLY PRES CRIBED QUA NTITY^N^^^ ^10^N
2659	"DATA",900 2313.91,12 1,5)
2660	EB^10
2661	"DATA",900 2313.91,12 1,10,0)
2662	^9002313.9 101^1^1^31 01115^
2663	"DATA",900 2313.91,12 1,10,1,0)
2664	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Quantity "))*1000\1
2665	"DATA",900 2313.91,12 1,20,0)
2666	^9002313.9 102^1^1^31 01101
2667	"DATA",900 2313.91,12 1,20,1,0)
2668	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
2669	"DATA",900 2313.91,12 1,25,0)
2670	^9002313.9 104^1^1^30 30828^^^^
2671	"DATA",900 2313.91,12 1,25,1,0)
2672	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
2673	"DATA",900 2313.91,12 1,30,0)
2674	^9002313.9 103^1^1^30 30828^^^^
2675	"DATA",900 2313.91,12 1,30,1,0)
2676	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 40),U,6)=B PS("X") ;V A
2677	"DATA",900 2313.91,12 2,0)
2678	454^^SCHED ULED PRESC RIPTION ID NUM^N^^^^ 12^A/N
2679	"DATA",900 2313.91,12 2,1)
2680	SCHEDULED PRESCRIPTI ON ID NUMB ER
2681	"DATA",900 2313.91,12 2,5)
2682	EK^12
2683	"DATA",900 2313.91,12 2,10,0)
2684	^9002313.9 101^1^1^30 40224
2685	"DATA",900 2313.91,12 2,10,1,0)
2686	S BPS("X") =""
2687	"DATA",900 2313.91,12 2,20,0)
2688	^9002313.9 102^1^1^31 01101
2689	"DATA",900 2313.91,12 2,20,1,0)
2690	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 2)
2691	"DATA",900 2313.91,12 2,25,0)
2692	^9002313.9 104^1^1^30 40224^^
2693	"DATA",900 2313.91,12 2,25,1,0)
2694	S BPS("X") =$$NFF^BPS ECFM(BPS(" X"),12)
2695	"DATA",900 2313.91,12 2,30,0)
2696	^9002313.9 103^1^1^30 40224^^
2697	"DATA",900 2313.91,12 2,30,1,0)
2698	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 50),U,4)=B PS("X")
2699	"DATA",900 2313.91,12 3,0)
2700	456^^ASSOC PRESCRIPT ION/SERV R EF NO^A/N^ ^^^12^N
2701	"DATA",900 2313.91,12 3,1)
2702	ASSOCIATED PRESCRIPT ION/ SERVI CE REFEREN CE NUMBER
2703	"DATA",900 2313.91,12 3,5)
2704	EN^7
2705	"DATA",900 2313.91,12 3,10,0)
2706	^9002313.9 101^1^1^30 30823
2707	"DATA",900 2313.91,12 3,10,1,0)
2708	S BPS("X") =""
2709	"DATA",900 2313.91,12 3,20,0)
2710	^9002313.9 102^1^1^31 01101
2711	"DATA",900 2313.91,12 3,20,1,0)
2712	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),12 )
2713	"DATA",900 2313.91,12 3,25,0)
2714	^9002313.9 104^1^1^30 30823^^
2715	"DATA",900 2313.91,12 3,25,1,0)
2716	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),7)
2717	"DATA",900 2313.91,12 3,30,0)
2718	^^1^1^3110 720^
2719	"DATA",900 2313.91,12 3,30,1,0)
2720	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 50),U,6)=$ S($G(BPS(" NCPDP","Ve rsion"))=5 1:BPS("X") ,1:"")
2721	"DATA",900 2313.91,12 4,0)
2722	457^^ASSOC PRESCRIPT ION/SERV D ATE^A/N^^^ ^8^N
2723	"DATA",900 2313.91,12 4,1)
2724	ASSOCIATED PRESCRIPT ION/ SERVI CE DATE
2725	"DATA",900 2313.91,12 4,5)
2726	EP^8
2727	"DATA",900 2313.91,12 4,10,0)
2728	^9002313.9 101^1^1^31 01029^
2729	"DATA",900 2313.91,12 4,10,1,0)
2730	S BPS("X") =""
2731	"DATA",900 2313.91,12 4,20,0)
2732	^9002313.9 102^1^1^31 01029^
2733	"DATA",900 2313.91,12 4,20,1,0)
2734	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
2735	"DATA",900 2313.91,12 4,25,0)
2736	^9002313.9 104^1^1^31 01029^
2737	"DATA",900 2313.91,12 4,25,1,0)
2738	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
2739	"DATA",900 2313.91,12 4,30,0)
2740	^9002313.9 103^1^1^31 10720^^
2741	"DATA",900 2313.91,12 4,30,1,0)
2742	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 50),U,7)=$ S($G(BPS(" NCPDP","Ve rsion"))=5 1:BPS("X") ,1:"")
2743	"DATA",900 2313.91,12 5,0)
2744	458^^PROCE DURE MODIF IER CODE C OUNT^N^^^^ 2^N
2745	"DATA",900 2313.91,12 5,5)
2746	SE^1
2747	"DATA",900 2313.91,12 5,10,0)
2748	^9002313.9 101^1^1^30 40819
2749	"DATA",900 2313.91,12 5,10,1,0)
2750	S BPS("X") =""
2751	"DATA",900 2313.91,12 5,20,0)
2752	^9002313.9 102^1^1^31 01101
2753	"DATA",900 2313.91,12 5,20,1,0)
2754	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
2755	"DATA",900 2313.91,12 5,25,0)
2756	^9002313.9 104^1^1^30 40819^^^^
2757	"DATA",900 2313.91,12 5,25,1,0)
2758	S BPS("X") =$$NFF^BPS ECFM(BPS(" X"),1)
2759	"DATA",900 2313.91,12 5,30,0)
2760	^9002313.9 103^1^1^30 40819^
2761	"DATA",900 2313.91,12 5,30,1,0)
2762	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 50),U,8)=" "
2763	"DATA",900 2313.91,12 6,0)
2764	459^^PROCE DURE MODIF IER CODE^A /N^^^^2^A/ N
2765	"DATA",900 2313.91,12 6,5)
2766	ER^2
2767	"DATA",900 2313.91,12 6,10,0)
2768	^9002313.9 101^1^1^30 40819
2769	"DATA",900 2313.91,12 6,10,1,0)
2770	S BPS("X") =""
2771	"DATA",900 2313.91,12 6,20,0)
2772	^9002313.9 102^1^1^31 01101
2773	"DATA",900 2313.91,12 6,20,1,0)
2774	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2775	"DATA",900 2313.91,12 6,25,0)
2776	^9002313.9 104^1^1^30 40819^^^^
2777	"DATA",900 2313.91,12 6,25,1,0)
2778	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),2)
2779	"DATA",900 2313.91,12 6,30,0)
2780	^^1^1^3110 727^
2781	"DATA",900 2313.91,12 6,30,1,0)
2782	; Not impl emented
2783	"DATA",900 2313.91,12 7,0)
2784	461^^PRIOR AUTHORIZA TION TYPE CODE^N^^^^ 2^N
2785	"DATA",900 2313.91,12 7,5)
2786	EU^2
2787	"DATA",900 2313.91,12 7,10,0)
2788	^9002313.9 101^2^2^31 01115^
2789	"DATA",900 2313.91,12 7,10,1,0)
2790	S BPS("X") =$G(BPS("C laim",BPS( 9002313.02 01),"Prior Auth Type "))
2791	"DATA",900 2313.91,12 7,10,2,0)
2792	S:BPS("X") ="" BPS("X ")=0
2793	"DATA",900 2313.91,12 7,20,0)
2794	^9002313.9 102^1^1^31 01101
2795	"DATA",900 2313.91,12 7,20,1,0)
2796	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
2797	"DATA",900 2313.91,12 7,25,0)
2798	^9002313.9 104^1^1^30 31222^^^^
2799	"DATA",900 2313.91,12 7,25,1,0)
2800	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
2801	"DATA",900 2313.91,12 7,30,0)
2802	^9002313.9 103^1^1^30 31222^^^^
2803	"DATA",900 2313.91,12 7,30,1,0)
2804	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 60),U,1)=B PS("X")
2805	"DATA",900 2313.91,12 8,0)
2806	462^^PRIOR AUTH NUMB ER SUBMITT ED^A/N^^^^ 11^N
2807	"DATA",900 2313.91,12 8,1)
2808	PRIOR AUTH ORIZATION NUMBER SUB MITTED
2809	"DATA",900 2313.91,12 8,5)
2810	EV^11
2811	"DATA",900 2313.91,12 8,10,0)
2812	^9002313.9 101^1^1^30 31222
2813	"DATA",900 2313.91,12 8,10,1,0)
2814	S BPS("X") =$G(BPS("C laim",BPS( 9002313.02 01),"Prior Auth Num Sub"))
2815	"DATA",900 2313.91,12 8,20,0)
2816	^9002313.9 102^1^1^31 01101
2817	"DATA",900 2313.91,12 8,20,1,0)
2818	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),11 )
2819	"DATA",900 2313.91,12 8,25,0)
2820	^9002313.9 104^1^1^30 31222^^^^
2821	"DATA",900 2313.91,12 8,25,1,0)
2822	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),11 )
2823	"DATA",900 2313.91,12 8,30,0)
2824	^9002313.9 103^1^1^30 31222^^^^
2825	"DATA",900 2313.91,12 8,30,1,0)
2826	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 60),U,2)=B PS("X")
2827	"DATA",900 2313.91,12 9,0)
2828	464^^INTER MEDIARY AU THORIZATIO N ID^A/N^^ ^^11^A/N
2829	"DATA",900 2313.91,12 9,5)
2830	EX^11
2831	"DATA",900 2313.91,12 9,10,0)
2832	^^2^2^3110 727^
2833	"DATA",900 2313.91,12 9,10,1,0)
2834	S BPS("X") =$G(BPS("C laim",BPS( 9002313.02 01),"Inter mediary Au th ID"))
2835	"DATA",900 2313.91,12 9,10,2,0)
2836	S:BPS("X") ="" BPS("X ")=""
2837	"DATA",900 2313.91,12 9,20,0)
2838	^9002313.9 102^1^1^31 01101
2839	"DATA",900 2313.91,12 9,20,1,0)
2840	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 1)
2841	"DATA",900 2313.91,12 9,25,0)
2842	^9002313.9 104^1^1^30 30823^
2843	"DATA",900 2313.91,12 9,25,1,0)
2844	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),11)
2845	"DATA",900 2313.91,12 9,30,0)
2846	^9002313.9 103^1^1^30 30823^^^
2847	"DATA",900 2313.91,12 9,30,1,0)
2848	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 60),U,4)=B PS("X")
2849	"DATA",900 2313.91,13 0,0)
2850	471^^OTHER PAYER REJ ECT COUNT^ N^^^^2^N
2851	"DATA",900 2313.91,13 0,5)
2852	5E^2
2853	"DATA",900 2313.91,13 0,10,0)
2854	^9002313.9 101^1^1^31 00916
2855	"DATA",900 2313.91,13 0,10,1,0)
2856	;GET code for this C OB field i s executed in COB^BP SOSHF
2857	"DATA",900 2313.91,13 0,20,0)
2858	^9002313.9 102^1^1^31 01101
2859	"DATA",900 2313.91,13 0,20,1,0)
2860	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
2861	"DATA",900 2313.91,13 0,25,0)
2862	^9002313.9 104^1^1^30 40224^^
2863	"DATA",900 2313.91,13 0,25,1,0)
2864	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
2865	"DATA",900 2313.91,13 0,30,0)
2866	^9002313.9 103^1^1^31 00824
2867	"DATA",900 2313.91,13 0,30,1,0)
2868	D SET471^B PSFLD01
2869	"DATA",900 2313.91,13 1,0)
2870	472^^OTHER PAYER REJ ECT CODE^A /N^^^^3^A/ N
2871	"DATA",900 2313.91,13 1,5)
2872	6E^3
2873	"DATA",900 2313.91,13 1,10,0)
2874	^9002313.9 101^1^1^31 01206^
2875	"DATA",900 2313.91,13 1,10,1,0)
2876	;GET code for this C OB field i s executed in COB^BP SOSHF
2877	"DATA",900 2313.91,13 1,20,0)
2878	^9002313.9 102^1^1^31 01206^
2879	"DATA",900 2313.91,13 1,20,1,0)
2880	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
2881	"DATA",900 2313.91,13 1,25,0)
2882	^9002313.9 104^1^1^30 40224^^^^
2883	"DATA",900 2313.91,13 1,25,1,0)
2884	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
2885	"DATA",900 2313.91,13 1,30,0)
2886	^9002313.9 103^1^1^31 01206^
2887	"DATA",900 2313.91,13 1,30,1,0)
2888	D SET472^B PSFLD01
2889	"DATA",900 2313.91,13 2,0)
2890	473^^DUR/P PS CODE CO UNTER^N^^^ ^1^N
2891	"DATA",900 2313.91,13 2,5)
2892	7E^1
2893	"DATA",900 2313.91,13 2,10,0)
2894	^9002313.9 101^1^1^30 31230
2895	"DATA",900 2313.91,13 2,10,1,0)
2896	S BPS("X") =1
2897	"DATA",900 2313.91,13 2,20,0)
2898	^9002313.9 102^1^1^31 01101
2899	"DATA",900 2313.91,13 2,20,1,0)
2900	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
2901	"DATA",900 2313.91,13 2,25,0)
2902	^9002313.9 104^1^1^30 31230^^^^
2903	"DATA",900 2313.91,13 2,25,1,0)
2904	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
2905	"DATA",900 2313.91,13 2,30,0)
2906	^9002313.9 103^1^1^30 31230^^^^
2907	"DATA",900 2313.91,13 2,30,1,0)
2908	D FLD473^B PSOSSG
2909	"DATA",900 2313.91,13 3,0)
2910	474^^DUR/P PS LEVEL O F EFFORT^N ^^^^2^N
2911	"DATA",900 2313.91,13 3,5)
2912	8E^2
2913	"DATA",900 2313.91,13 3,10,0)
2914	^9002313.9 101^1^1^30 30718
2915	"DATA",900 2313.91,13 3,10,1,0)
2916	S BPS("X") =12
2917	"DATA",900 2313.91,13 3,20,0)
2918	^9002313.9 102^1^1^31 01101
2919	"DATA",900 2313.91,13 3,20,1,0)
2920	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
2921	"DATA",900 2313.91,13 3,25,0)
2922	^9002313.9 104^1^1^30 30718^
2923	"DATA",900 2313.91,13 3,25,1,0)
2924	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
2925	"DATA",900 2313.91,13 3,30,0)
2926	^9002313.9 103^1^1^30 30718^
2927	"DATA",900 2313.91,13 3,30,1,0)
2928	D FLD474^B PSOSSG
2929	"DATA",900 2313.91,13 4,0)
2930	475^^DUR C O-AGENT ID QUALIFIER ^A/N^^^^2^ A/N
2931	"DATA",900 2313.91,13 4,5)
2932	J9^2
2933	"DATA",900 2313.91,13 4,10,0)
2934	^9002313.9 101^1^1^30 30718
2935	"DATA",900 2313.91,13 4,10,1,0)
2936	S BPS("X") =""
2937	"DATA",900 2313.91,13 4,20,0)
2938	^9002313.9 102^1^1^31 01101
2939	"DATA",900 2313.91,13 4,20,1,0)
2940	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2941	"DATA",900 2313.91,13 4,25,0)
2942	^9002313.9 104^1^1^30 30718^
2943	"DATA",900 2313.91,13 4,25,1,0)
2944	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
2945	"DATA",900 2313.91,13 4,30,0)
2946	^9002313.9 103^1^1^30 30718^
2947	"DATA",900 2313.91,13 4,30,1,0)
2948	D FLD475^B PSOSSG
2949	"DATA",900 2313.91,13 5,0)
2950	476^^DUR C O-AGENT ID ^A/N^^^^19 ^A/N
2951	"DATA",900 2313.91,13 5,5)
2952	H6^19
2953	"DATA",900 2313.91,13 5,10,0)
2954	^9002313.9 101^1^1^31 01115^
2955	"DATA",900 2313.91,13 5,10,1,0)
2956	S BPS("X") =""
2957	"DATA",900 2313.91,13 5,20,0)
2958	^9002313.9 102^1^1^31 01101
2959	"DATA",900 2313.91,13 5,20,1,0)
2960	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 9)
2961	"DATA",900 2313.91,13 5,25,0)
2962	^9002313.9 104^1^1^30 40107^^^
2963	"DATA",900 2313.91,13 5,25,1,0)
2964	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 9)
2965	"DATA",900 2313.91,13 5,30,0)
2966	^9002313.9 103^1^1^31 01115^^^^
2967	"DATA",900 2313.91,13 5,30,1,0)
2968	D FLD476^B PSOSSG
2969	"DATA",900 2313.91,13 6,0)
2970	477^^PROF SERVICE FE E SUBMITTE D^D^^^^8^D
2971	"DATA",900 2313.91,13 6,1)
2972	PROFESSION AL SERVICE FEE SUBMI TTED
2973	"DATA",900 2313.91,13 6,5)
2974	BE^8
2975	"DATA",900 2313.91,13 6,10,0)
2976	^9002313.9 101^1^1^31 00916
2977	"DATA",900 2313.91,13 6,10,1,0)
2978	S BPS("X") =0
2979	"DATA",900 2313.91,13 6,20,0)
2980	^9002313.9 102^1^1^31 01101
2981	"DATA",900 2313.91,13 6,20,1,0)
2982	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
2983	"DATA",900 2313.91,13 6,25,0)
2984	^9002313.9 104^1^1^31 01029^
2985	"DATA",900 2313.91,13 6,25,1,0)
2986	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
2987	"DATA",900 2313.91,13 6,30,0)
2988	^9002313.9 103^1^1^30 30823^^
2989	"DATA",900 2313.91,13 6,30,1,0)
2990	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 70),U,7)=B PS("X")
2991	"DATA",900 2313.91,13 9,0)
2992	481^^FLAT SALES TAX AMT SUBMIT TED^D^^^^8 ^D
2993	"DATA",900 2313.91,13 9,1)
2994	FLAT SALES TAX AMOUN T SUBMITTE D
2995	"DATA",900 2313.91,13 9,5)
2996	HA^8
2997	"DATA",900 2313.91,13 9,10,0)
2998	^9002313.9 101^1^1^31 00916
2999	"DATA",900 2313.91,13 9,10,1,0)
3000	S BPS("X") =0
3001	"DATA",900 2313.91,13 9,20,0)
3002	^9002313.9 102^1^1^31 01101
3003	"DATA",900 2313.91,13 9,20,1,0)
3004	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3005	"DATA",900 2313.91,13 9,25,0)
3006	^9002313.9 104^1^1^30 40907^^
3007	"DATA",900 2313.91,13 9,25,1,0)
3008	S BPS("X") =$$DFF^BPS ECFM(BPS(" X"),8)
3009	"DATA",900 2313.91,13 9,30,0)
3010	^9002313.9 103^1^1^31 00923^^^^
3011	"DATA",900 2313.91,13 9,30,1,0)
3012	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 80),U,1)=$ S($G(BPS(" NCPDP","Ve rsion"))=5 1:BPS("X") ,1:"")
3013	"DATA",900 2313.91,14 0,0)
3014	482^^PERCE NT SALES T AX AMT SBM TTD^D^^^^8 ^D
3015	"DATA",900 2313.91,14 0,1)
3016	PERCENTAGE SALES TAX AMOUNT SU BMITTED
3017	"DATA",900 2313.91,14 0,5)
3018	GE^8
3019	"DATA",900 2313.91,14 0,10,0)
3020	^9002313.9 101^1^1^30 50802
3021	"DATA",900 2313.91,14 0,10,1,0)
3022	S BPS("X") =0
3023	"DATA",900 2313.91,14 0,20,0)
3024	^9002313.9 102^1^1^31 01101
3025	"DATA",900 2313.91,14 0,20,1,0)
3026	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3027	"DATA",900 2313.91,14 0,25,0)
3028	^9002313.9 104^1^1^30 40907^^^^
3029	"DATA",900 2313.91,14 0,25,1,0)
3030	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3031	"DATA",900 2313.91,14 0,30,0)
3032	^9002313.9 103^1^1^31 00923^^^^
3033	"DATA",900 2313.91,14 0,30,1,0)
3034	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 80),U,2)=$ S($G(BPS(" NCPDP","Ve rsion"))=5 1:BPS("X") ,1:"")
3035	"DATA",900 2313.91,14 1,0)
3036	483^^PERCE NT SALES T AX RATE SB MTTD^D^^^^ 7^D
3037	"DATA",900 2313.91,14 1,1)
3038	PERCENTAGE SALES TAX RATE SUBM ITTED
3039	"DATA",900 2313.91,14 1,5)
3040	HE^7
3041	"DATA",900 2313.91,14 1,10,0)
3042	^9002313.9 101^1^1^31 01029^
3043	"DATA",900 2313.91,14 1,10,1,0)
3044	S BPS("X") =+$G(BPS(" Insurer"," Percent Sa les Tax Ra te Sub"))
3045	"DATA",900 2313.91,14 1,20,0)
3046	^^1^1^3121 128
3047	"DATA",900 2313.91,14 1,20,1,0)
3048	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),7, 4)
3049	"DATA",900 2313.91,14 1,25,0)
3050	^^1^1^3121 128
3051	"DATA",900 2313.91,14 1,25,1,0)
3052	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),7, 4)
3053	"DATA",900 2313.91,14 1,30,0)
3054	^9002313.9 103^1^1^31 00923^^^^
3055	"DATA",900 2313.91,14 1,30,1,0)
3056	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 80),U,3)=$ S($G(BPS(" NCPDP","Ve rsion"))=5 1:BPS("X") ,1:"")
3057	"DATA",900 2313.91,14 2,0)
3058	484^^PERCE NT SALES T AX BASIS S BMTTD^A/N^ ^^^2^A/N
3059	"DATA",900 2313.91,14 2,1)
3060	PERCENTAGE SALES TAX BASIS SUB MITTED
3061	"DATA",900 2313.91,14 2,5)
3062	JE^2
3063	"DATA",900 2313.91,14 2,10,0)
3064	^9002313.9 101^1^1^30 50802
3065	"DATA",900 2313.91,14 2,10,1,0)
3066	S BPS("X") =""
3067	"DATA",900 2313.91,14 2,20,0)
3068	^9002313.9 102^1^1^31 01101
3069	"DATA",900 2313.91,14 2,20,1,0)
3070	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
3071	"DATA",900 2313.91,14 2,25,0)
3072	^9002313.9 104^1^1^30 30824^
3073	"DATA",900 2313.91,14 2,25,1,0)
3074	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),2)
3075	"DATA",900 2313.91,14 2,30,0)
3076	^9002313.9 103^1^1^31 00923^^^^
3077	"DATA",900 2313.91,14 2,30,1,0)
3078	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 80),U,4)=$ S($G(BPS(" NCPDP","Ve rsion"))=5 1:BPS("X") ,1:"")
3079	"DATA",900 2313.91,14 3,0)
3080	485^^COUPO N TYPE^A/N ^^^^2^A/N
3081	"DATA",900 2313.91,14 3,5)
3082	KE^2
3083	"DATA",900 2313.91,14 3,10,0)
3084	^9002313.9 101^1^1^31 01115^
3085	"DATA",900 2313.91,14 3,10,1,0)
3086	S BPS("X") =""
3087	"DATA",900 2313.91,14 3,20,0)
3088	^9002313.9 102^1^1^31 01101
3089	"DATA",900 2313.91,14 3,20,1,0)
3090	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
3091	"DATA",900 2313.91,14 3,25,0)
3092	^9002313.9 104^1^1^30 40107^^
3093	"DATA",900 2313.91,14 3,25,1,0)
3094	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
3095	"DATA",900 2313.91,14 3,30,0)
3096	^9002313.9 103^1^1^31 01115^^^
3097	"DATA",900 2313.91,14 3,30,1,0)
3098	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 80),U,5)=B PS("X")
3099	"DATA",900 2313.91,14 4,0)
3100	486^^COUPO N NUMBER^A /N^^^^15^A /N
3101	"DATA",900 2313.91,14 4,5)
3102	ME^15
3103	"DATA",900 2313.91,14 4,10,0)
3104	^9002313.9 101^1^1^31 01115^
3105	"DATA",900 2313.91,14 4,10,1,0)
3106	S BPS("X") =""
3107	"DATA",900 2313.91,14 4,20,0)
3108	^9002313.9 102^1^1^31 01101
3109	"DATA",900 2313.91,14 4,20,1,0)
3110	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
3111	"DATA",900 2313.91,14 4,25,0)
3112	^9002313.9 104^1^1^30 31210^^
3113	"DATA",900 2313.91,14 4,25,1,0)
3114	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
3115	"DATA",900 2313.91,14 4,30,0)
3116	^9002313.9 103^1^1^30 31210^^
3117	"DATA",900 2313.91,14 4,30,1,0)
3118	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 80),U,6)=B PS("X")
3119	"DATA",900 2313.91,14 5,0)
3120	487^^COUPO N VALUE AM OUNT^D^^^^ 8^D
3121	"DATA",900 2313.91,14 5,5)
3122	NE^8
3123	"DATA",900 2313.91,14 5,10,0)
3124	^9002313.9 101^1^1^31 01115^
3125	"DATA",900 2313.91,14 5,10,1,0)
3126	S BPS("X") =""
3127	"DATA",900 2313.91,14 5,20,0)
3128	^9002313.9 102^1^1^31 01101
3129	"DATA",900 2313.91,14 5,20,1,0)
3130	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3131	"DATA",900 2313.91,14 5,25,0)
3132	^9002313.9 104^1^1^30 31210^^
3133	"DATA",900 2313.91,14 5,25,1,0)
3134	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3135	"DATA",900 2313.91,14 5,30,0)
3136	^9002313.9 103^1^1^30 31210^^
3137	"DATA",900 2313.91,14 5,30,1,0)
3138	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 80),U,7)=B PS("X")
3139	"DATA",900 2313.91,14 6,0)
3140	491^^DIAGN OSIS CODE COUNT^N^^^ ^1^N
3141	"DATA",900 2313.91,14 6,5)
3142	VE^1
3143	"DATA",900 2313.91,14 6,10,0)
3144	^9002313.9 101^1^1^31 01115^
3145	"DATA",900 2313.91,14 6,10,1,0)
3146	S BPS("X") =""
3147	"DATA",900 2313.91,14 6,20,0)
3148	^9002313.9 102^1^1^31 01101
3149	"DATA",900 2313.91,14 6,20,1,0)
3150	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
3151	"DATA",900 2313.91,14 6,25,0)
3152	^9002313.9 104^1^1^30 40107^^^^
3153	"DATA",900 2313.91,14 6,25,1,0)
3154	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
3155	"DATA",900 2313.91,14 7,0)
3156	492^^DIAGN OSIS CODE QUALIFIER^ A/N^^^^2^A /N
3157	"DATA",900 2313.91,14 7,5)
3158	WE^2
3159	"DATA",900 2313.91,14 7,10,0)
3160	^9002313.9 101^1^1^30 40224
3161	"DATA",900 2313.91,14 7,10,1,0)
3162	S BPS("X") =""
3163	"DATA",900 2313.91,14 7,20,0)
3164	^9002313.9 102^1^1^31 01101
3165	"DATA",900 2313.91,14 7,20,1,0)
3166	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
3167	"DATA",900 2313.91,14 7,25,0)
3168	^9002313.9 104^1^1^30 40224^^^
3169	"DATA",900 2313.91,14 7,25,1,0)
3170	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
3171	"DATA",900 2313.91,14 8,0)
3172	493^^CLINI CAL INFORM ATION COUN TER^N^^^^1 ^N
3173	"DATA",900 2313.91,14 8,5)
3174	XE^1
3175	"DATA",900 2313.91,14 8,10,0)
3176	^9002313.9 101^1^1^30 40224
3177	"DATA",900 2313.91,14 8,10,1,0)
3178	S BPS("X") =""
3179	"DATA",900 2313.91,14 8,20,0)
3180	^9002313.9 102^1^1^31 01101
3181	"DATA",900 2313.91,14 8,20,1,0)
3182	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
3183	"DATA",900 2313.91,14 8,25,0)
3184	^9002313.9 104^1^1^30 40224^^^^
3185	"DATA",900 2313.91,14 8,25,1,0)
3186	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
3187	"DATA",900 2313.91,14 9,0)
3188	498.01^^RE QUEST TYPE ^N^^^^1^A/ N
3189	"DATA",900 2313.91,14 9,5)
3190	PA^1
3191	"DATA",900 2313.91,14 9,10,0)
3192	^9002313.9 101^1^1^30 40428
3193	"DATA",900 2313.91,14 9,10,1,0)
3194	S BPS("X") =""
3195	"DATA",900 2313.91,14 9,20,0)
3196	^9002313.9 102^1^1^31 01101
3197	"DATA",900 2313.91,14 9,20,1,0)
3198	S BPS("X") =""
3199	"DATA",900 2313.91,14 9,25,0)
3200	^9002313.9 104^1^1^30 40428^
3201	"DATA",900 2313.91,14 9,25,1,0)
3202	S BPS("X") =""
3203	"DATA",900 2313.91,15 0,0)
3204	498.02^^RE QUEST PERI OD DATE-BE GIN^A/N^^^ ^8^N
3205	"DATA",900 2313.91,15 0,5)
3206	PB^8
3207	"DATA",900 2313.91,15 0,10,0)
3208	^9002313.9 101^1^1^30 40223
3209	"DATA",900 2313.91,15 0,10,1,0)
3210	S BPS("X") =""
3211	"DATA",900 2313.91,15 0,20,0)
3212	^9002313.9 102^1^1^31 01101
3213	"DATA",900 2313.91,15 0,20,1,0)
3214	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
3215	"DATA",900 2313.91,15 1,0)
3216	498.03^^RE QUEST PERI OD DATE-EN D^A/N^^^^8 ^N
3217	"DATA",900 2313.91,15 1,5)
3218	PC^8
3219	"DATA",900 2313.91,15 1,10,0)
3220	^9002313.9 101^1^1^30 40223
3221	"DATA",900 2313.91,15 1,10,1,0)
3222	S BPS("X") =""
3223	"DATA",900 2313.91,15 1,20,0)
3224	^9002313.9 102^1^1^31 01101
3225	"DATA",900 2313.91,15 1,20,1,0)
3226	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
3227	"DATA",900 2313.91,15 2,0)
3228	498.04^^BA SIS OF REQ UEST^A/N^^ ^^2^A/N
3229	"DATA",900 2313.91,15 2,5)
3230	PD^2
3231	"DATA",900 2313.91,15 2,10,0)
3232	^9002313.9 101^1^1^30 40223
3233	"DATA",900 2313.91,15 2,10,1,0)
3234	S BPS("X") =""
3235	"DATA",900 2313.91,15 2,20,0)
3236	^9002313.9 102^1^1^31 01101
3237	"DATA",900 2313.91,15 2,20,1,0)
3238	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
3239	"DATA",900 2313.91,15 3,0)
3240	498.05^^AU THORIZED R EP FIRST N AME^A/N^^^ ^12^A/N
3241	"DATA",900 2313.91,15 3,5)
3242	PE^12
3243	"DATA",900 2313.91,15 3,10,0)
3244	^9002313.9 101^1^1^30 40223
3245	"DATA",900 2313.91,15 3,10,1,0)
3246	S BPS("X") =""
3247	"DATA",900 2313.91,15 3,20,0)
3248	^9002313.9 102^1^1^31 01101
3249	"DATA",900 2313.91,15 3,20,1,0)
3250	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 2)
3251	"DATA",900 2313.91,15 4,0)
3252	498.06^^AU THORIZED R EP LAST NA ME^A/N^^^^ 15^A/N
3253	"DATA",900 2313.91,15 4,5)
3254	PF^15
3255	"DATA",900 2313.91,15 4,10,0)
3256	^9002313.9 101^1^1^30 40223
3257	"DATA",900 2313.91,15 4,10,1,0)
3258	S BPS("X") =""
3259	"DATA",900 2313.91,15 4,20,0)
3260	^9002313.9 102^1^1^31 01101
3261	"DATA",900 2313.91,15 4,20,1,0)
3262	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
3263	"DATA",900 2313.91,15 5,0)
3264	498.07^^AU THORIZED R EP STREET ADDRESS^A/ N^^^^30^A/ N
3265	"DATA",900 2313.91,15 5,5)
3266	PG^30
3267	"DATA",900 2313.91,15 5,10,0)
3268	^9002313.9 101^1^1^30 40223
3269	"DATA",900 2313.91,15 5,10,1,0)
3270	S BPS("X") =""
3271	"DATA",900 2313.91,15 5,20,0)
3272	^9002313.9 102^1^1^31 01101
3273	"DATA",900 2313.91,15 5,20,1,0)
3274	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
3275	"DATA",900 2313.91,15 6,0)
3276	498.08^^AU TH REP CIT Y ADDRESS^ A/N^^^^20^ A/N
3277	"DATA",900 2313.91,15 6,5)
3278	PH^20
3279	"DATA",900 2313.91,15 6,10,0)
3280	^9002313.9 101^1^1^30 40223
3281	"DATA",900 2313.91,15 6,10,1,0)
3282	S BPS("X") =""
3283	"DATA",900 2313.91,15 6,20,0)
3284	^9002313.9 102^1^1^31 01101
3285	"DATA",900 2313.91,15 6,20,1,0)
3286	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
3287	"DATA",900 2313.91,15 7,0)
3288	498.09^^AU THORIZED R EP STATE/P ROV ADDR^A /N^^^^2^A/ N
3289	"DATA",900 2313.91,15 7,5)
3290	PJ^2
3291	"DATA",900 2313.91,15 7,10,0)
3292	^9002313.9 101^1^1^31 01206^
3293	"DATA",900 2313.91,15 7,10,1,0)
3294	S BPS("X") =""
3295	"DATA",900 2313.91,15 7,20,0)
3296	^9002313.9 102^1^1^31 01206^
3297	"DATA",900 2313.91,15 7,20,1,0)
3298	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
3299	"DATA",900 2313.91,15 8,0)
3300	498.11^^AU THORIZED R EP ZIP/POS TAL ZONE^A /N^^^^15^A /N
3301	"DATA",900 2313.91,15 8,1)
3302	AUTHORIZED REPRESENT ATIVE ZIP/ POSTAL ZON E
3303	"DATA",900 2313.91,15 8,5)
3304	PK^15
3305	"DATA",900 2313.91,15 8,10,0)
3306	^9002313.9 101^1^1^30 40223
3307	"DATA",900 2313.91,15 8,10,1,0)
3308	S BPS("X") =""
3309	"DATA",900 2313.91,15 8,20,0)
3310	^9002313.9 102^1^1^31 01101
3311	"DATA",900 2313.91,15 8,20,1,0)
3312	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
3313	"DATA",900 2313.91,15 9,0)
3314	498.12^^PR ESCRIBER T ELEPHONE N UMBER^N^^^ ^10^N
3315	"DATA",900 2313.91,15 9,5)
3316	PM^10
3317	"DATA",900 2313.91,15 9,10,0)
3318	^9002313.9 101^1^1^30 50802
3319	"DATA",900 2313.91,15 9,10,1,0)
3320	S BPS("X") =$TR($G(BP S("RX",BPS (9002313.0 201),"Pres criber Pho ne #")),"# () -_*.@")
3321	"DATA",900 2313.91,15 9,20,0)
3322	^9002313.9 102^1^1^31 01101
3323	"DATA",900 2313.91,15 9,20,1,0)
3324	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
3325	"DATA",900 2313.91,15 9,25,0)
3326	^9002313.9 104^1^1^30 30722^^
3327	"DATA",900 2313.91,15 9,25,1,0)
3328	S BPS("X") =$$NFF^BPS ECFM(BPS(" X"),10)
3329	"DATA",900 2313.91,15 9,30,0)
3330	^9002313.9 103^1^1^30 30722^^
3331	"DATA",900 2313.91,15 9,30,1,0)
3332	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 98),U,12)= BPS("X")
3333	"DATA",900 2313.91,16 0,0)
3334	498.13^^PR IOR AUTH S UPPORTING DOCUMENT^A /N^^^^500^ A/N
3335	"DATA",900 2313.91,16 0,5)
3336	PP^200
3337	"DATA",900 2313.91,16 0,10,0)
3338	^9002313.9 101^1^1^30 40223
3339	"DATA",900 2313.91,16 0,10,1,0)
3340	S BPS("X") =""
3341	"DATA",900 2313.91,16 0,20,0)
3342	^9002313.9 102^1^1^31 01101
3343	"DATA",900 2313.91,16 0,20,1,0)
3344	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),5 00)
3345	"DATA",900 2313.91,16 1,0)
3346	498.14^^PR IOR AUTH N UMBER-ASSI GNED^N^^^^ 11^N
3347	"DATA",900 2313.91,16 1,5)
3348	PY^8
3349	"DATA",900 2313.91,16 1,10,0)
3350	^9002313.9 101^1^1^30 40223
3351	"DATA",900 2313.91,16 1,10,1,0)
3352	S BPS("X") =""
3353	"DATA",900 2313.91,16 1,20,0)
3354	^9002313.9 102^1^1^31 01101
3355	"DATA",900 2313.91,16 1,20,1,0)
3356	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),11 )
3357	"DATA",900 2313.91,16 2,0)
3358	498.52^^PR IOR AUTH E FFECTIVE D ATE^A/N^^^ ^8^N
3359	"DATA",900 2313.91,16 2,5)
3360	PS^8
3361	"DATA",900 2313.91,16 2,10,0)
3362	^9002313.9 101^1^1^30 40223
3363	"DATA",900 2313.91,16 2,10,1,0)
3364	S BPS("X") =""
3365	"DATA",900 2313.91,16 2,20,0)
3366	^9002313.9 102^1^1^31 01101
3367	"DATA",900 2313.91,16 2,20,1,0)
3368	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
3369	"DATA",900 2313.91,16 3,0)
3370	498.53^^PR IOR AUTH E XPIRATION DATE^A/N^^ ^^8^N
3371	"DATA",900 2313.91,16 3,5)
3372	PT^8
3373	"DATA",900 2313.91,16 3,10,0)
3374	^9002313.9 101^1^1^30 40223
3375	"DATA",900 2313.91,16 3,10,1,0)
3376	S BPS("X") =""
3377	"DATA",900 2313.91,16 3,20,0)
3378	^9002313.9 102^1^1^31 01101
3379	"DATA",900 2313.91,16 3,20,1,0)
3380	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
3381	"DATA",900 2313.91,16 4,0)
3382	498.54^^PR IOR AUTH N O REFILLS AUTH^N^^^^ 2^N
3383	"DATA",900 2313.91,16 4,5)
3384	PW^8
3385	"DATA",900 2313.91,16 4,10,0)
3386	^9002313.9 101^1^1^30 40223
3387	"DATA",900 2313.91,16 4,10,1,0)
3388	S BPS("X") =""
3389	"DATA",900 2313.91,16 4,20,0)
3390	^9002313.9 102^1^1^31 01101
3391	"DATA",900 2313.91,16 4,20,1,0)
3392	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
3393	"DATA",900 2313.91,16 5,0)
3394	498.55^^PR IOR AUTH Q TY ACCUMUL ATED^N^^^^ 10^N
3395	"DATA",900 2313.91,16 5,5)
3396	PX^8
3397	"DATA",900 2313.91,16 5,10,0)
3398	^9002313.9 101^1^1^30 40223
3399	"DATA",900 2313.91,16 5,10,1,0)
3400	S BPS("X") =""
3401	"DATA",900 2313.91,16 5,20,0)
3402	^9002313.9 102^1^1^31 01101
3403	"DATA",900 2313.91,16 5,20,1,0)
3404	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
3405	"DATA",900 2313.91,16 6,0)
3406	498.57^^PR IOR AUTHOR IZATION QU ANTITY^A/N ^^^^10^N
3407	"DATA",900 2313.91,16 6,5)
3408	RA^3
3409	"DATA",900 2313.91,16 6,10,0)
3410	^9002313.9 101^1^1^30 40223
3411	"DATA",900 2313.91,16 6,10,1,0)
3412	S BPS("X") =""
3413	"DATA",900 2313.91,16 6,20,0)
3414	^9002313.9 102^1^1^31 01101
3415	"DATA",900 2313.91,16 6,20,1,0)
3416	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
3417	"DATA",900 2313.91,16 7,0)
3418	498.58^^PR IOR AUTH D OLLARS AUT HORIZED^N^ ^^^8^D
3419	"DATA",900 2313.91,16 7,5)
3420	RB^8
3421	"DATA",900 2313.91,16 7,10,0)
3422	^9002313.9 101^1^1^30 40223
3423	"DATA",900 2313.91,16 7,10,1,0)
3424	S BPS("X") =""
3425	"DATA",900 2313.91,16 7,20,0)
3426	^9002313.9 102^1^1^31 01101
3427	"DATA",900 2313.91,16 7,20,1,0)
3428	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3429	"DATA",900 2313.91,16 8,0)
3430	498.59^^AU TH REP CIT Y ADDRESS^ A/N^^^^20^ A/N
3431	"DATA",900 2313.91,16 8,5)
3432	PH^20
3433	"DATA",900 2313.91,16 8,10,0)
3434	^9002313.9 101^1^1^30 30512
3435	"DATA",900 2313.91,16 8,10,1,0)
3436	S BPS("X") =""
3437	"DATA",900 2313.91,16 8,20,0)
3438	^9002313.9 102^1^1^31 01101
3439	"DATA",900 2313.91,16 8,20,1,0)
3440	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
3441	"DATA",900 2313.91,16 9,0)
3442	501^^HEADE R RESPONSE STATUS^A/ N^^^^1^A/N
3443	"DATA",900 2313.91,16 9,5)
3444	F1^1
3445	"DATA",900 2313.91,16 9,10,0)
3446	^9002313.9 101^1^1^31 01115^
3447	"DATA",900 2313.91,16 9,10,1,0)
3448	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3449	"DATA",900 2313.91,16 9,25,0)
3450	^9002313.9 104^1^1^30 40202^^^
3451	"DATA",900 2313.91,16 9,25,1,0)
3452	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
3453	"DATA",900 2313.91,16 9,30,0)
3454	^9002313.9 103^1^1^30 40202^^^
3455	"DATA",900 2313.91,16 9,30,1,0)
3456	S $P(^BPSR (BPS(90023 13.02),500 ),U,1)=BPS ("X")
3457	"DATA",900 2313.91,17 0,0)
3458	503^^AUTHO RIZATION N UMBER^A/N^ ^^^20^A/N
3459	"DATA",900 2313.91,17 0,5)
3460	F3^20
3461	"DATA",900 2313.91,17 0,10,0)
3462	^9002313.9 101^1^1^31 01115^
3463	"DATA",900 2313.91,17 0,10,1,0)
3464	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3465	"DATA",900 2313.91,17 0,30,0)
3466	^^1^1^3031 205^
3467	"DATA",900 2313.91,17 0,30,1,0)
3468	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),U,3)= BPS("X")
3469	"DATA",900 2313.91,17 1,0)
3470	504^^MESSA GE^A/N^^^^ 200^A/N
3471	"DATA",900 2313.91,17 1,5)
3472	F4^200
3473	"DATA",900 2313.91,17 1,10,0)
3474	^9002313.9 101^1^1^31 01115^
3475	"DATA",900 2313.91,17 1,10,1,0)
3476	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3477	"DATA",900 2313.91,17 1,25,0)
3478	^^1^1^3031 211^
3479	"DATA",900 2313.91,17 1,25,1,0)
3480	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 00)
3481	"DATA",900 2313.91,17 1,30,0)
3482	^^1^1^3031 211^
3483	"DATA",900 2313.91,17 1,30,1,0)
3484	S $P(^BPSR (BPS(90023 13.02),504 ),U,1)=BPS ("X")
3485	"DATA",900 2313.91,17 2,0)
3486	505^^PATIE NT PAY AMO UNT^A/N^^^ ^8^D
3487	"DATA",900 2313.91,17 2,5)
3488	F5^8
3489	"DATA",900 2313.91,17 2,10,0)
3490	^9002313.9 101^1^1^31 01115^
3491	"DATA",900 2313.91,17 2,10,1,0)
3492	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3493	"DATA",900 2313.91,17 2,25,0)
3494	^9002313.9 104^1^1^30 31212^^
3495	"DATA",900 2313.91,17 2,25,1,0)
3496	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3497	"DATA",900 2313.91,17 2,30,0)
3498	^9002313.9 103^1^1^30 31212^^
3499	"DATA",900 2313.91,17 2,30,1,0)
3500	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),U,5)= S BPS("X")
3501	"DATA",900 2313.91,17 3,0)
3502	506^^INGRE DIENT COST PAID^A/N^ ^^^8^D
3503	"DATA",900 2313.91,17 3,5)
3504	F6^8
3505	"DATA",900 2313.91,17 3,10,0)
3506	^9002313.9 101^1^1^31 01115^
3507	"DATA",900 2313.91,17 3,10,1,0)
3508	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3509	"DATA",900 2313.91,17 3,25,0)
3510	^9002313.9 104^1^1^30 31211^^
3511	"DATA",900 2313.91,17 3,25,1,0)
3512	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3513	"DATA",900 2313.91,17 3,30,0)
3514	^9002313.9 103^1^1^30 31211^^
3515	"DATA",900 2313.91,17 3,30,1,0)
3516	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),U,6)= BPS("X")
3517	"DATA",900 2313.91,17 4,0)
3518	507^^DISPE NSING FEE PAID^A/N^^ ^^8^D
3519	"DATA",900 2313.91,17 4,5)
3520	F7^8
3521	"DATA",900 2313.91,17 4,10,0)
3522	^9002313.9 101^1^1^31 01115^
3523	"DATA",900 2313.91,17 4,10,1,0)
3524	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3525	"DATA",900 2313.91,17 4,25,0)
3526	^9002313.9 104^1^1^30 31210^^^
3527	"DATA",900 2313.91,17 4,25,1,0)
3528	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3529	"DATA",900 2313.91,17 4,30,0)
3530	^9002313.9 103^1^1^30 31210^^^
3531	"DATA",900 2313.91,17 4,30,1,0)
3532	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),U,7)= BPS("X")
3533	"DATA",900 2313.91,17 5,0)
3534	509^^TOTAL AMOUNT PA ID^A/N^^^^ 8^D
3535	"DATA",900 2313.91,17 5,5)
3536	F9^8
3537	"DATA",900 2313.91,17 5,10,0)
3538	^9002313.9 101^1^1^31 01115^^
3539	"DATA",900 2313.91,17 5,10,1,0)
3540	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3541	"DATA",900 2313.91,17 5,25,0)
3542	^9002313.9 104^1^1^30 31217^^
3543	"DATA",900 2313.91,17 5,25,1,0)
3544	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3545	"DATA",900 2313.91,17 5,30,0)
3546	^9002313.9 103^1^1^30 31217^^
3547	"DATA",900 2313.91,17 5,30,1,0)
3548	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),U,9)
3549	"DATA",900 2313.91,17 6,0)
3550	510^^REJEC T COUNT^N^ ^^^2^N
3551	"DATA",900 2313.91,17 6,5)
3552	FA^2
3553	"DATA",900 2313.91,17 6,10,0)
3554	^9002313.9 101^1^1^31 01115^^
3555	"DATA",900 2313.91,17 6,10,1,0)
3556	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3557	"DATA",900 2313.91,17 6,25,0)
3558	^^1^1^3031 217^
3559	"DATA",900 2313.91,17 6,25,1,0)
3560	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
3561	"DATA",900 2313.91,17 6,30,0)
3562	^^1^1^3031 217^
3563	"DATA",900 2313.91,17 6,30,1,0)
3564	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),U,10) =BPS("X")
3565	"DATA",900 2313.91,17 7,0)
3566	511^^REJEC T CODE^A/N ^^^^3^A/N
3567	"DATA",900 2313.91,17 7,5)
3568	FB^3
3569	"DATA",900 2313.91,17 7,10,0)
3570	^9002313.9 101^1^1^31 01115^^
3571	"DATA",900 2313.91,17 7,10,1,0)
3572	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3573	"DATA",900 2313.91,17 7,25,0)
3574	^9002313.9 104^1^1^30 31217^^
3575	"DATA",900 2313.91,17 7,25,1,0)
3576	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
3577	"DATA",900 2313.91,17 7,30,0)
3578	^9002313.9 103^1^1^30 31217^^
3579	"DATA",900 2313.91,17 7,30,1,0)
3580	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 511,DUR,0) ,U,1)
3581	"DATA",900 2313.91,17 8,0)
3582	512^^ACCUM ULATED DED UCTIBLE AM OUNT^A/N^^ ^^8^D
3583	"DATA",900 2313.91,17 8,5)
3584	FC^8
3585	"DATA",900 2313.91,17 8,10,0)
3586	^9002313.9 101^1^1^31 01115^
3587	"DATA",900 2313.91,17 8,10,1,0)
3588	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3589	"DATA",900 2313.91,17 8,25,0)
3590	^9002313.9 104^1^1^30 31210^^^^
3591	"DATA",900 2313.91,17 8,25,1,0)
3592	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),8 )
3593	"DATA",900 2313.91,17 8,30,0)
3594	^9002313.9 103^1^1^30 31210^^^^
3595	"DATA",900 2313.91,17 8,30,1,0)
3596	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),"^",1 0)=BPS("X" )
3597	"DATA",900 2313.91,17 9,0)
3598	513^^REMAI NING DEDUC TIBLE AMOU NT^A/N^^^^ 8^D
3599	"DATA",900 2313.91,17 9,5)
3600	FD^8
3601	"DATA",900 2313.91,17 9,10,0)
3602	^9002313.9 101^1^1^31 01115^
3603	"DATA",900 2313.91,17 9,10,1,0)
3604	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3605	"DATA",900 2313.91,17 9,25,0)
3606	^9002313.9 104^1^1^30 31217^^
3607	"DATA",900 2313.91,17 9,25,1,0)
3608	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3609	"DATA",900 2313.91,17 9,30,0)
3610	^9002313.9 103^1^1^30 31217^^
3611	"DATA",900 2313.91,17 9,30,1,0)
3612	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),U,13) =BPS("X")
3613	"DATA",900 2313.91,18 0,0)
3614	514^^REMAI NING BENEF IT AMOUNT^ A/N^^^^8^D
3615	"DATA",900 2313.91,18 0,5)
3616	FE^8
3617	"DATA",900 2313.91,18 0,10,0)
3618	^9002313.9 101^1^1^31 01115^
3619	"DATA",900 2313.91,18 0,10,1,0)
3620	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3621	"DATA",900 2313.91,18 0,25,0)
3622	^9002313.9 104^1^1^30 31217^^^
3623	"DATA",900 2313.91,18 0,25,1,0)
3624	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3625	"DATA",900 2313.91,18 0,30,0)
3626	^9002313.9 103^1^1^30 31217^^^
3627	"DATA",900 2313.91,18 0,30,1,0)
3628	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),U,14)
3629	"DATA",900 2313.91,18 2,0)
3630	517^^AMT A PPLIED TO PERIODIC D EDUCT^D^^^ ^8^D
3631	"DATA",900 2313.91,18 2,5)
3632	FH^8
3633	"DATA",900 2313.91,18 2,10,0)
3634	^9002313.9 101^1^1^31 01115^
3635	"DATA",900 2313.91,18 2,10,1,0)
3636	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3637	"DATA",900 2313.91,18 2,25,0)
3638	^9002313.9 104^1^1^30 31205^^^
3639	"DATA",900 2313.91,18 2,25,1,0)
3640	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3641	"DATA",900 2313.91,18 2,30,0)
3642	^9002313.9 103^1^1^30 31205^^
3643	"DATA",900 2313.91,18 2,30,1,0)
3644	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),"^",1 7)=BPS("X" )
3645	"DATA",900 2313.91,18 3,0)
3646	518^^AMOUN T OF COPAY ^D^^^^8^D
3647	"DATA",900 2313.91,18 3,5)
3648	FI^8
3649	"DATA",900 2313.91,18 3,10,0)
3650	^9002313.9 101^1^1^31 01115^
3651	"DATA",900 2313.91,18 3,10,1,0)
3652	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3653	"DATA",900 2313.91,18 3,25,0)
3654	^^1^1^3031 205^
3655	"DATA",900 2313.91,18 3,25,1,0)
3656	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3657	"DATA",900 2313.91,18 3,30,0)
3658	^^1^1^3031 205^
3659	"DATA",900 2313.91,18 3,30,1,0)
3660	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),"^",1 8)=BPS("X" )
3661	"DATA",900 2313.91,18 4,0)
3662	519^^AMT A TTRIBUTED TO PRODUCT SEL^D^^^^ 8^D
3663	"DATA",900 2313.91,18 4,5)
3664	FJ^8
3665	"DATA",900 2313.91,18 4,10,0)
3666	^9002313.9 101^1^1^31 01115^
3667	"DATA",900 2313.91,18 4,10,1,0)
3668	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3669	"DATA",900 2313.91,18 4,25,0)
3670	^^1^1^3031 205^
3671	"DATA",900 2313.91,18 4,25,1,0)
3672	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3673	"DATA",900 2313.91,18 4,30,0)
3674	^^1^1^3031 205^
3675	"DATA",900 2313.91,18 4,30,1,0)
3676	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),U,19) =BPS("X")
3677	"DATA",900 2313.91,18 5,0)
3678	520^^AMOUN T EXCEEDIN G PERIODIC MAX^D^^^^ 8^D
3679	"DATA",900 2313.91,18 5,5)
3680	FK^8
3681	"DATA",900 2313.91,18 5,10,0)
3682	^9002313.9 101^1^1^31 01115^
3683	"DATA",900 2313.91,18 5,10,1,0)
3684	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3685	"DATA",900 2313.91,18 5,25,0)
3686	^^1^1^3031 205^
3687	"DATA",900 2313.91,18 5,25,1,0)
3688	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3689	"DATA",900 2313.91,18 5,30,0)
3690	^^1^1^3031 205^
3691	"DATA",900 2313.91,18 5,30,1,0)
3692	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),U,20) =BPS("X")
3693	"DATA",900 2313.91,18 6,0)
3694	521^^INCEN TIVE AMOUN T PAID^A/N ^^^^8^D
3695	"DATA",900 2313.91,18 6,5)
3696	FL^8
3697	"DATA",900 2313.91,18 6,10,0)
3698	^9002313.9 101^1^1^31 01115^
3699	"DATA",900 2313.91,18 6,10,1,0)
3700	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3701	"DATA",900 2313.91,18 6,25,0)
3702	^^1^1^3031 210^
3703	"DATA",900 2313.91,18 6,25,1,0)
3704	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3705	"DATA",900 2313.91,18 6,30,0)
3706	^^1^1^3031 210^
3707	"DATA",900 2313.91,18 6,30,1,0)
3708	$P(^BPSR(B PS(9002313 .02),1000, BPS(900231 3.0201),50 0),U,21)=B PS("X")
3709	"DATA",900 2313.91,18 7,0)
3710	522^^BASIS OF REIMB DETERMINAT ION^N^^^^2 ^N
3711	"DATA",900 2313.91,18 7,5)
3712	FM^2
3713	"DATA",900 2313.91,18 7,10,0)
3714	^9002313.9 101^1^1^31 01115^
3715	"DATA",900 2313.91,18 7,10,1,0)
3716	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3717	"DATA",900 2313.91,18 7,25,0)
3718	^^1^1^3031 205^
3719	"DATA",900 2313.91,18 7,25,1,0)
3720	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
3721	"DATA",900 2313.91,18 7,30,0)
3722	^^1^1^3031 205^
3723	"DATA",900 2313.91,18 7,30,1,0)
3724	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),U,22) =BPS("X")
3725	"DATA",900 2313.91,18 8,0)
3726	523^^AMOUN T ATTRIBUT ED TO SALE S TAX^D^^^ ^8^D
3727	"DATA",900 2313.91,18 8,5)
3728	FN^8
3729	"DATA",900 2313.91,18 8,10,0)
3730	^9002313.9 101^1^1^31 01115^
3731	"DATA",900 2313.91,18 8,10,1,0)
3732	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3733	"DATA",900 2313.91,18 8,25,0)
3734	^^1^1^3031 205^
3735	"DATA",900 2313.91,18 8,25,1,0)
3736	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
3737	"DATA",900 2313.91,18 8,30,0)
3738	^^1^1^3031 205^
3739	"DATA",900 2313.91,18 8,30,1,0)
3740	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 500),"^",2 3)=BPS("X" )
3741	"DATA",900 2313.91,18 9,0)
3742	524^^PLAN ID^A/N^^^^ 8^A/N
3743	"DATA",900 2313.91,18 9,5)
3744	FO^8
3745	"DATA",900 2313.91,18 9,10,0)
3746	^^1^1^3110 301^
3747	"DATA",900 2313.91,18 9,10,1,0)
3748	S BPS("X") =$G(BPS("I nsurer","P lan ID"))
3749	"DATA",900 2313.91,18 9,20,0)
3750	^9002313.9 102^1^1^31 01101
3751	"DATA",900 2313.91,18 9,20,1,0)
3752	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),8 )
3753	"DATA",900 2313.91,18 9,25,0)
3754	^9002313.9 104^1^1^30 61122^
3755	"DATA",900 2313.91,18 9,25,1,0)
3756	S BPS("X") =$$ANFF^BP SECFM(BPS( "X"),8)
3757	"DATA",900 2313.91,18 9,30,0)
3758	^9002313.9 103^1^1^30 30825^^^^
3759	"DATA",900 2313.91,18 9,30,1,0)
3760	S $P(^BPSC (BPS(90023 13.02),520 ),U,4)=BPS ("X")
3761	"DATA",900 2313.91,19 1,0)
3762	526^^ADDIT IONAL MESS AGE INFORM ATION^A/N^ ^^^40^A/N
3763	"DATA",900 2313.91,19 1,5)
3764	FQ^200
3765	"DATA",900 2313.91,19 1,10,0)
3766	^9002313.9 101^1^1^31 01115^
3767	"DATA",900 2313.91,19 1,10,1,0)
3768	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3769	"DATA",900 2313.91,19 1,25,0)
3770	^9002313.9 104^1^1^30 31210^^^^
3771	"DATA",900 2313.91,19 1,25,1,0)
3772	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 00)
3773	"DATA",900 2313.91,19 1,30,0)
3774	^9002313.9 103^1^1^30 31210^^^^
3775	"DATA",900 2313.91,19 1,30,1,0)
3776	S ^BPSR(BP S(9002313. 02),1000,B PS(9002313 .0201),526 )=BPS("X")
3777	"DATA",900 2313.91,19 2,0)
3778	528^^CLINI CAL SIGNIF ICANCE COD E^A/N^^^^1 ^A/N
3779	"DATA",900 2313.91,19 2,5)
3780	FS^1
3781	"DATA",900 2313.91,19 2,10,0)
3782	^9002313.9 101^1^1^31 01115^
3783	"DATA",900 2313.91,19 2,10,1,0)
3784	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3785	"DATA",900 2313.91,19 2,25,0)
3786	^9002313.9 104^1^1^30 31210^^^^
3787	"DATA",900 2313.91,19 2,25,1,0)
3788	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
3789	"DATA",900 2313.91,19 2,30,0)
3790	^9002313.9 103^1^1^30 31210^^^^
3791	"DATA",900 2313.91,19 2,30,1,0)
3792	S ^BPSR(BP S(9002313. 02),1000,B PS(9002313 .0201),525 )=$G(BPS(" X"))
3793	"DATA",900 2313.91,19 3,0)
3794	529^^OTHER PHARMACY INDICATOR^ A/N^^^^1^N
3795	"DATA",900 2313.91,19 3,5)
3796	FT^1
3797	"DATA",900 2313.91,19 3,10,0)
3798	^9002313.9 101^1^1^30 31212
3799	"DATA",900 2313.91,19 3,10,1,0)
3800	S BPS("X") =""
3801	"DATA",900 2313.91,19 3,20,0)
3802	^9002313.9 102^1^1^31 01101
3803	"DATA",900 2313.91,19 3,20,1,0)
3804	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
3805	"DATA",900 2313.91,19 4,0)
3806	530^^PREVI OUS DATE O F FILL^A/N ^^^^8^N
3807	"DATA",900 2313.91,19 4,5)
3808	FU^8
3809	"DATA",900 2313.91,19 4,10,0)
3810	^9002313.9 101^1^1^31 01115^
3811	"DATA",900 2313.91,19 4,10,1,0)
3812	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3813	"DATA",900 2313.91,19 4,25,0)
3814	^^1^1^3031 216^
3815	"DATA",900 2313.91,19 4,25,1,0)
3816	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X"))
3817	"DATA",900 2313.91,19 4,30,0)
3818	^^1^1^3031 216^
3819	"DATA",900 2313.91,19 4,30,1,0)
3820	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 567.01,DUR ,0),U,5)=B PS("X")
3821	"DATA",900 2313.91,19 5,0)
3822	531^^QUANT ITY OF PRE VIOUS FILL ^N^^^^10^N
3823	"DATA",900 2313.91,19 5,5)
3824	FV^8
3825	"DATA",900 2313.91,19 5,10,0)
3826	^9002313.9 101^1^1^31 01115^
3827	"DATA",900 2313.91,19 5,10,1,0)
3828	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3829	"DATA",900 2313.91,19 5,25,0)
3830	^9002313.9 104^1^1^30 31217^^
3831	"DATA",900 2313.91,19 5,25,1,0)
3832	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
3833	"DATA",900 2313.91,19 5,30,0)
3834	^9002313.9 103^1^1^30 31217^^
3835	"DATA",900 2313.91,19 5,30,1,0)
3836	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 567.01,DUR ,0),U,6)=B PS("X")
3837	"DATA",900 2313.91,19 6,0)
3838	532^^DATAB ASE INDICA TOR^A/N^^^ ^1^A/N
3839	"DATA",900 2313.91,19 6,5)
3840	FW^1
3841	"DATA",900 2313.91,19 6,10,0)
3842	^9002313.9 101^1^1^31 01115^
3843	"DATA",900 2313.91,19 6,10,1,0)
3844	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3845	"DATA",900 2313.91,19 6,25,0)
3846	^9002313.9 104^1^1^30 31210^^^
3847	"DATA",900 2313.91,19 6,25,1,0)
3848	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
3849	"DATA",900 2313.91,19 6,30,0)
3850	^9002313.9 103^1^1^30 31210^^^
3851	"DATA",900 2313.91,19 6,30,1,0)
3852	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 567.01,BPS (9002313.0 20101),0), U,7)=BPS(" X")
3853	"DATA",900 2313.91,19 7,0)
3854	533^^OTHER PRESCRIBE R INDICATO R^A/N^^^^1 ^N
3855	"DATA",900 2313.91,19 7,5)
3856	FX^1
3857	"DATA",900 2313.91,19 7,10,0)
3858	^9002313.9 101^1^1^31 01115^
3859	"DATA",900 2313.91,19 7,10,1,0)
3860	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3861	"DATA",900 2313.91,19 7,25,0)
3862	^^1^1^3031 212^
3863	"DATA",900 2313.91,19 7,25,1,0)
3864	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
3865	"DATA",900 2313.91,19 7,30,0)
3866	^^1^1^3031 212^
3867	"DATA",900 2313.91,19 7,30,1,0)
3868	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 567.01,DUR ,0),U,8)=B PS("X")
3869	"DATA",900 2313.91,19 9,0)
3870	544^^DUR F REE TEXT M ESSAGE^A/N ^^^^30^A/N
3871	"DATA",900 2313.91,19 9,5)
3872	FY^30
3873	"DATA",900 2313.91,19 9,10,0)
3874	^9002313.9 101^1^1^31 01116^
3875	"DATA",900 2313.91,19 9,10,1,0)
3876	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3877	"DATA",900 2313.91,19 9,25,0)
3878	^9002313.9 104^1^1^30 31210^^
3879	"DATA",900 2313.91,19 9,25,1,0)
3880	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
3881	"DATA",900 2313.91,19 9,30,0)
3882	^9002313.9 103^1^1^30 31210^^
3883	"DATA",900 2313.91,19 9,30,1,0)
3884	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 567.01,DUR ,0),U,9)=B PS("X")
3885	"DATA",900 2313.91,20 0,0)
3886	545^^NETWO RK REIMBUR SEMENT ID^ A/N^^^^10^ A/N
3887	"DATA",900 2313.91,20 0,5)
3888	2F^10
3889	"DATA",900 2313.91,20 0,10,0)
3890	^9002313.9 101^1^1^30 40223
3891	"DATA",900 2313.91,20 0,10,1,0)
3892	S BPS("X") =""
3893	"DATA",900 2313.91,20 0,20,0)
3894	^9002313.9 102^1^1^31 01101
3895	"DATA",900 2313.91,20 0,20,1,0)
3896	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0)
3897	"DATA",900 2313.91,20 1,0)
3898	546^^REJEC TED FLD OC CURRENCE I NDCTR^A/N^ ^^^2^N
3899	"DATA",900 2313.91,20 1,5)
3900	4F^2
3901	"DATA",900 2313.91,20 1,10,0)
3902	^9002313.9 101^1^1^31 01115^
3903	"DATA",900 2313.91,20 1,10,1,0)
3904	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3905	"DATA",900 2313.91,20 1,25,0)
3906	^9002313.9 104^1^1^30 31217^^
3907	"DATA",900 2313.91,20 1,25,1,0)
3908	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
3909	"DATA",900 2313.91,20 1,30,0)
3910	^9002313.9 103^1^1^30 31217^^
3911	"DATA",900 2313.91,20 1,30,1,0)
3912	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 511,DUR,0) ,U,2)=BPS( "X")
3913	"DATA",900 2313.91,20 2,0)
3914	547^^APPRO VED MESSAG E CODE COU NT^A/N^^^^ 1^N
3915	"DATA",900 2313.91,20 2,5)
3916	5F^1
3917	"DATA",900 2313.91,20 2,10,0)
3918	^9002313.9 101^1^1^31 01115^
3919	"DATA",900 2313.91,20 2,10,1,0)
3920	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3921	"DATA",900 2313.91,20 2,25,0)
3922	^^1^1^3031 205^
3923	"DATA",900 2313.91,20 2,25,1,0)
3924	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
3925	"DATA",900 2313.91,20 2,30,0)
3926	^^1^1^3031 205^
3927	"DATA",900 2313.91,20 2,30,1,0)
3928	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 540),U,7)= BPS("X")
3929	"DATA",900 2313.91,20 3,0)
3930	548^^APPRO VED MESSAG E CODE^A/N ^^^^3^A/N
3931	"DATA",900 2313.91,20 3,5)
3932	6F^3
3933	"DATA",900 2313.91,20 3,10,0)
3934	^9002313.9 101^1^1^31 01115^
3935	"DATA",900 2313.91,20 3,10,1,0)
3936	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3937	"DATA",900 2313.91,20 3,25,0)
3938	^9002313.9 104^1^1^30 31210^^^
3939	"DATA",900 2313.91,20 3,25,1,0)
3940	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
3941	"DATA",900 2313.91,20 3,30,0)
3942	^9002313.9 103^1^1^30 31210^^^
3943	"DATA",900 2313.91,20 3,30,1,0)
3944	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 548,0),B,4 )=BPS("X")
3945	"DATA",900 2313.91,20 4,0)
3946	549^^HELP DESK PHONE NUMBER QU AL^A/N^^^^ 2^A/N
3947	"DATA",900 2313.91,20 4,1)
3948	HELP DESK TELEPHONE NUMBER QUA LIFER
3949	"DATA",900 2313.91,20 4,5)
3950	7F^2
3951	"DATA",900 2313.91,20 4,10,0)
3952	^9002313.9 101^1^1^31 01115^
3953	"DATA",900 2313.91,20 4,10,1,0)
3954	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3955	"DATA",900 2313.91,20 4,25,0)
3956	^^1^1^3031 210^
3957	"DATA",900 2313.91,20 4,25,1,0)
3958	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
3959	"DATA",900 2313.91,20 4,30,0)
3960	^^1^1^3031 210^
3961	"DATA",900 2313.91,20 4,30,1,0)
3962	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 540),U,9)= BPS("X")
3963	"DATA",900 2313.91,20 5,0)
3964	550^^HELP DESK TELEP HONE NUMBE R^A/N^^^^1 8^A/N
3965	"DATA",900 2313.91,20 5,5)
3966	8F^18
3967	"DATA",900 2313.91,20 5,10,0)
3968	^9002313.9 101^1^1^31 01115^
3969	"DATA",900 2313.91,20 5,10,1,0)
3970	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3971	"DATA",900 2313.91,20 5,25,0)
3972	^9002313.9 104^1^1^30 31210^^
3973	"DATA",900 2313.91,20 5,25,1,0)
3974	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 8)
3975	"DATA",900 2313.91,20 5,30,0)
3976	^9002313.9 103^1^1^30 31210^^
3977	"DATA",900 2313.91,20 5,30,1,0)
3978	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 540),U,10) =BPS("X")
3979	"DATA",900 2313.91,20 6,0)
3980	551^^PREFE RRED PRODU CT COUNT^A /N^^^^1^N
3981	"DATA",900 2313.91,20 6,5)
3982	9F^1
3983	"DATA",900 2313.91,20 6,10,0)
3984	^9002313.9 101^1^1^30 31216
3985	"DATA",900 2313.91,20 6,10,1,0)
3986	S BPS("X") =""
3987	"DATA",900 2313.91,20 6,20,0)
3988	^9002313.9 102^1^1^31 01101
3989	"DATA",900 2313.91,20 6,20,1,0)
3990	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
3991	"DATA",900 2313.91,20 7,0)
3992	552^^PREFE RRED PRODU CT ID QUAL IFIER^A/N^ ^^^2^A/N
3993	"DATA",900 2313.91,20 7,5)
3994	AP^2
3995	"DATA",900 2313.91,20 7,10,0)
3996	^9002313.9 101^1^1^31 01115^
3997	"DATA",900 2313.91,20 7,10,1,0)
3998	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
3999	"DATA",900 2313.91,20 7,25,0)
4000	^^1^1^3031 216^
4001	"DATA",900 2313.91,20 7,25,1,0)
4002	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4003	"DATA",900 2313.91,20 7,30,0)
4004	^^1^1^3031 216^
4005	"DATA",900 2313.91,20 7,30,1,0)
4006	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 551.01,DUR ,1),U,1)=B PS("X")
4007	"DATA",900 2313.91,20 8,0)
4008	553^^PREFE RRED PRODU CT ID^A/N^ ^^^19^A/N
4009	"DATA",900 2313.91,20 8,5)
4010	AR^19
4011	"DATA",900 2313.91,20 8,10,0)
4012	^9002313.9 101^1^1^31 01115^^
4013	"DATA",900 2313.91,20 8,10,1,0)
4014	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4015	"DATA",900 2313.91,20 8,25,0)
4016	^^1^1^3031 216^
4017	"DATA",900 2313.91,20 8,25,1,0)
4018	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 9)
4019	"DATA",900 2313.91,20 8,30,0)
4020	^^1^1^3031 216^
4021	"DATA",900 2313.91,20 8,30,1,0)
4022	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 551.01,DUR ,1),U,2)=B PS("X")
4023	"DATA",900 2313.91,20 9,0)
4024	554^^PREFE RRED PRODU CT INCENTI VE^A/N^^^^ 8^D
4025	"DATA",900 2313.91,20 9,5)
4026	AS^8
4027	"DATA",900 2313.91,20 9,10,0)
4028	^9002313.9 101^1^1^31 01115^
4029	"DATA",900 2313.91,20 9,10,1,0)
4030	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4031	"DATA",900 2313.91,20 9,25,0)
4032	^^1^1^3031 216^
4033	"DATA",900 2313.91,20 9,25,1,0)
4034	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
4035	"DATA",900 2313.91,20 9,30,0)
4036	^^1^1^3031 216^
4037	"DATA",900 2313.91,20 9,30,1,0)
4038	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 551.01,DUR ,1),U,3)=B PS("X")
4039	"DATA",900 2313.91,21 0,0)
4040	555^^PREF PRODUCT CO ST SHARE I NCNTV^A/N^ ^^^8^D
4041	"DATA",900 2313.91,21 0,5)
4042	AT^8
4043	"DATA",900 2313.91,21 0,10,0)
4044	^9002313.9 101^1^1^31 01115^
4045	"DATA",900 2313.91,21 0,10,1,0)
4046	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4047	"DATA",900 2313.91,21 0,25,0)
4048	^9002313.9 104^1^1^30 31216^^
4049	"DATA",900 2313.91,21 0,25,1,0)
4050	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
4051	"DATA",900 2313.91,21 0,30,0)
4052	^9002313.9 103^1^1^30 31216^^
4053	"DATA",900 2313.91,21 0,30,1,0)
4054	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 551.01,DUR ,1),U,4)=B PS("X")
4055	"DATA",900 2313.91,21 1,0)
4056	556^^PREFE RRED PRODU CT DESCRIP TION^A/N^^ ^^40^A/N
4057	"DATA",900 2313.91,21 1,5)
4058	AU^40
4059	"DATA",900 2313.91,21 1,10,0)
4060	^9002313.9 101^1^1^31 01115^
4061	"DATA",900 2313.91,21 1,10,1,0)
4062	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4063	"DATA",900 2313.91,21 1,25,0)
4064	^^1^1^3031 216^
4065	"DATA",900 2313.91,21 1,25,1,0)
4066	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
4067	"DATA",900 2313.91,21 1,30,0)
4068	^^1^1^3031 216^
4069	"DATA",900 2313.91,21 1,30,1,0)
4070	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 551.01,DUR ,1),U,5)=B PS("X")
4071	"DATA",900 2313.91,21 2,0)
4072	557^^TAX E XEMPT INDI CATOR^A/N^ ^^^1^A/N
4073	"DATA",900 2313.91,21 2,5)
4074	AV^1
4075	"DATA",900 2313.91,21 2,10,0)
4076	^9002313.9 101^1^1^31 01115^
4077	"DATA",900 2313.91,21 2,10,1,0)
4078	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4079	"DATA",900 2313.91,21 2,25,0)
4080	^^1^1^3031 217^
4081	"DATA",900 2313.91,21 2,25,1,0)
4082	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
4083	"DATA",900 2313.91,21 2,30,0)
4084	^^1^1^3031 217^
4085	"DATA",900 2313.91,21 2,30,1,0)
4086	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 550),U,7)
4087	"DATA",900 2313.91,21 3,0)
4088	558^^FLAT SALES TAX AMOUNT PAI D^A/N^^^^8 ^D
4089	"DATA",900 2313.91,21 3,5)
4090	AW^8
4091	"DATA",900 2313.91,21 3,10,0)
4092	^9002313.9 101^1^1^31 01115^
4093	"DATA",900 2313.91,21 3,10,1,0)
4094	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4095	"DATA",900 2313.91,21 3,25,0)
4096	^9002313.9 104^1^1^30 31210^^
4097	"DATA",900 2313.91,21 3,25,1,0)
4098	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
4099	"DATA",900 2313.91,21 3,30,0)
4100	^9002313.9 103^1^1^30 31210^^
4101	"DATA",900 2313.91,21 3,30,1,0)
4102	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 550),U,8)= BPS("X")
4103	"DATA",900 2313.91,21 4,0)
4104	559^^PERCE NTAGE SALE S TAX AMT PAID^A/N^^ ^^8^D
4105	"DATA",900 2313.91,21 4,5)
4106	AX^8
4107	"DATA",900 2313.91,21 4,10,0)
4108	^9002313.9 101^1^1^31 01115^
4109	"DATA",900 2313.91,21 4,10,1,0)
4110	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4111	"DATA",900 2313.91,21 4,25,0)
4112	^9002313.9 104^1^1^30 31212^^
4113	"DATA",900 2313.91,21 4,25,1,0)
4114	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
4115	"DATA",900 2313.91,21 4,30,0)
4116	^9002313.9 103^1^1^30 31212^^^
4117	"DATA",900 2313.91,21 4,30,1,0)
4118	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 550),U,9)= BPS("X")
4119	"DATA",900 2313.91,21 5,0)
4120	560^^PERCE NTAGE SALE S TAX RATE PAID^A/N^ ^^^7^D
4121	"DATA",900 2313.91,21 5,5)
4122	AY^8
4123	"DATA",900 2313.91,21 5,10,0)
4124	^9002313.9 101^1^1^30 40223
4125	"DATA",900 2313.91,21 5,10,1,0)
4126	S BPS("X") =""
4127	"DATA",900 2313.91,21 5,20,0)
4128	^9002313.9 102^1^1^31 01101
4129	"DATA",900 2313.91,21 5,20,1,0)
4130	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),7)
4131	"DATA",900 2313.91,21 6,0)
4132	561^^PERCE NT SALES T AX BASIS P AID^A/N^^^ ^2^A/N
4133	"DATA",900 2313.91,21 6,5)
4134	AZ^8
4135	"DATA",900 2313.91,21 6,10,0)
4136	^9002313.9 101^1^1^30 31212
4137	"DATA",900 2313.91,21 6,10,1,0)
4138	S BPS("X") =""
4139	"DATA",900 2313.91,21 6,20,0)
4140	^9002313.9 102^1^1^31 01101
4141	"DATA",900 2313.91,21 6,20,1,0)
4142	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4143	"DATA",900 2313.91,21 7,0)
4144	562^^PROFE SSIONAL SE RVICE FEE PAID^A/N^^ ^^8^D
4145	"DATA",900 2313.91,21 7,5)
4146	J1^8
4147	"DATA",900 2313.91,21 7,10,0)
4148	^9002313.9 101^1^1^31 01115^
4149	"DATA",900 2313.91,21 7,10,1,0)
4150	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4151	"DATA",900 2313.91,21 7,25,0)
4152	^^1^1^3031 217^
4153	"DATA",900 2313.91,21 7,25,1,0)
4154	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),8 )
4155	"DATA",900 2313.91,21 7,30,0)
4156	^^1^1^3031 217^
4157	"DATA",900 2313.91,21 7,30,1,0)
4158	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 560),U,2)= BPS("X")
4159	"DATA",900 2313.91,21 8,0)
4160	563^^OTHER AMOUNT PA ID COUNT^N ^^^^1^N
4161	"DATA",900 2313.91,21 8,5)
4162	J2^1
4163	"DATA",900 2313.91,21 8,10,0)
4164	^9002313.9 101^1^1^31 01115^
4165	"DATA",900 2313.91,21 8,10,1,0)
4166	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4167	"DATA",900 2313.91,21 8,25,0)
4168	^^1^1^3031 212^
4169	"DATA",900 2313.91,21 8,25,1,0)
4170	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
4171	"DATA",900 2313.91,21 8,30,0)
4172	^^1^1^3031 212^
4173	"DATA",900 2313.91,21 8,30,1,0)
4174	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 563.01,DUR ,0)),U,1)
4175	"DATA",900 2313.91,21 9,0)
4176	564^^OTHER AMOUNT PA ID QUALIFI ER^A/N^^^^ 2^A/N
4177	"DATA",900 2313.91,21 9,5)
4178	J3^2
4179	"DATA",900 2313.91,21 9,10,0)
4180	^9002313.9 101^1^1^31 01115^
4181	"DATA",900 2313.91,21 9,10,1,0)
4182	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4183	"DATA",900 2313.91,21 9,25,0)
4184	^^1^1^3031 212^
4185	"DATA",900 2313.91,21 9,25,1,0)
4186	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4187	"DATA",900 2313.91,21 9,30,0)
4188	^^1^1^3031 212^
4189	"DATA",900 2313.91,21 9,30,1,0)
4190	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 563.01,DUR ,1),U,1)=B PS("X")
4191	"DATA",900 2313.91,22 0,0)
4192	565^^OTHER AMOUNT PA ID^A/N^^^^ 8^D
4193	"DATA",900 2313.91,22 0,5)
4194	J4^8
4195	"DATA",900 2313.91,22 0,10,0)
4196	^9002313.9 101^1^1^31 01115^
4197	"DATA",900 2313.91,22 0,10,1,0)
4198	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4199	"DATA",900 2313.91,22 0,25,0)
4200	^9002313.9 104^1^1^30 31212^^
4201	"DATA",900 2313.91,22 0,25,1,0)
4202	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),8 )
4203	"DATA",900 2313.91,22 0,30,0)
4204	^9002313.9 103^1^1^30 31212^^
4205	"DATA",900 2313.91,22 0,30,1,0)
4206	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 563.01,DUR ,1),U,2)=B PS("X")
4207	"DATA",900 2313.91,22 1,0)
4208	566^^OTHER PAYER AMO UNT RECOGN IZED^A/N^^ ^^8^D
4209	"DATA",900 2313.91,22 1,5)
4210	J5^8
4211	"DATA",900 2313.91,22 1,10,0)
4212	^9002313.9 101^1^1^31 01115^^
4213	"DATA",900 2313.91,22 1,10,1,0)
4214	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4215	"DATA",900 2313.91,22 1,25,0)
4216	^^1^1^3090 304^
4217	"DATA",900 2313.91,22 1,25,1,0)
4218	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),6)
4219	"DATA",900 2313.91,22 1,30,0)
4220	^^1^1^3090 304^
4221	"DATA",900 2313.91,22 1,30,1,0)
4222	D SET566^B PSFLD01
4223	"DATA",900 2313.91,22 2,0)
4224	567^^DUR/P PS RESPONS E CODE COU NTER^N^^^^ 1^N
4225	"DATA",900 2313.91,22 2,5)
4226	J6^1
4227	"DATA",900 2313.91,22 2,10,0)
4228	^9002313.9 101^1^1^31 01115^
4229	"DATA",900 2313.91,22 2,10,1,0)
4230	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4231	"DATA",900 2313.91,22 2,25,0)
4232	^9002313.9 104^1^1^30 31210^^
4233	"DATA",900 2313.91,22 2,25,1,0)
4234	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
4235	"DATA",900 2313.91,22 2,30,0)
4236	^9002313.9 103^1^1^30 31210^^
4237	"DATA",900 2313.91,22 2,30,1,0)
4238	S $P(^BPSR (BPS(90023 13.02),100 0,BPS(9002 313.0201), 567.01,DUR ,0),U,1)=B PS("X")
4239	"DATA",900 2313.91,22 3,0)
4240	568^^PAYER ID QUALIF IER^A/N^^^ ^2^A/N
4241	"DATA",900 2313.91,22 3,5)
4242	J7^2
4243	"DATA",900 2313.91,22 3,10,0)
4244	^9002313.9 101^1^1^31 01115^
4245	"DATA",900 2313.91,22 3,10,1,0)
4246	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4247	"DATA",900 2313.91,22 3,25,0)
4248	^^1^1^3031 212^
4249	"DATA",900 2313.91,22 3,25,1,0)
4250	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4251	"DATA",900 2313.91,22 3,30,0)
4252	^^1^1^3031 212^
4253	"DATA",900 2313.91,22 3,30,1,0)
4254	S $P(^BPSR (BPS(90023 13.02),560 ),U,8)
4255	"DATA",900 2313.91,22 4,0)
4256	569^^PAYER ID^A/N^^^ ^10^A/N
4257	"DATA",900 2313.91,22 4,5)
4258	J8^10
4259	"DATA",900 2313.91,22 4,10,0)
4260	^9002313.9 101^1^1^31 01115^
4261	"DATA",900 2313.91,22 4,10,1,0)
4262	;This is R esponse-on ly field w hich does not use th e GET FORM AT or SET code
4263	"DATA",900 2313.91,22 4,25,0)
4264	^9002313.9 104^1^1^30 31212^^
4265	"DATA",900 2313.91,22 4,25,1,0)
4266	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0)
4267	"DATA",900 2313.91,22 4,30,0)
4268	^9002313.9 103^1^1^30 31212^^
4269	"DATA",900 2313.91,22 4,30,1,0)
4270	S $P(^BPSR (BPS(90023 13.02),560 ),U,9)=BPS ("X")
4271	"DATA",900 2313.91,22 5,0)
4272	600^^UNIT OF MEASURE ^A/N^^^^2^ A/N
4273	"DATA",900 2313.91,22 5,5)
4274	28^2
4275	"DATA",900 2313.91,22 5,10,0)
4276	^9002313.9 101^1^1^30 70625
4277	"DATA",900 2313.91,22 5,10,1,0)
4278	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Unit of Measure"))
4279	"DATA",900 2313.91,22 5,20,0)
4280	^9002313.9 102^1^1^31 01101
4281	"DATA",900 2313.91,22 5,20,1,0)
4282	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4283	"DATA",900 2313.91,22 5,25,0)
4284	^9002313.9 104^1^1^30 70620^
4285	"DATA",900 2313.91,22 5,25,1,0)
4286	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4287	"DATA",900 2313.91,22 5,30,0)
4288	^9002313.9 103^1^1^30 70620^
4289	"DATA",900 2313.91,22 5,30,1,0)
4290	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),6 00),U,1)=" "
4291	"DATA",900 2313.91,24 0,0)
4292	478^^OTHER AMT CLAIM ED SBMTTD COUNT^N^^^ ^1^N
4293	"DATA",900 2313.91,24 0,1)
4294	OTHER AMOU NT CLAIMED SUBMITTED COUNT
4295	"DATA",900 2313.91,24 0,5)
4296	H7^1
4297	"DATA",900 2313.91,24 0,10,0)
4298	^9002313.9 101^1^1^31 01006^^^
4299	"DATA",900 2313.91,24 0,10,1,0)
4300	; fields 4 78, 479, 4 80 handled by FLD480 ^BPSOSSG ( see SET CO DE in fiel d 480)
4301	"DATA",900 2313.91,24 0,20,0)
4302	^9002313.9 102^1^1^31 01006^^^
4303	"DATA",900 2313.91,24 0,20,1,0)
4304	; fields 4 78, 479, 4 80 handled by FLD480 ^BPSOSSG ( see SET CO DE in fiel d 480)
4305	"DATA",900 2313.91,24 0,25,0)
4306	^9002313.9 104^1^1^31 01006^^
4307	"DATA",900 2313.91,24 0,25,1,0)
4308	; fields 4 78, 479, 4 80 handled by FLD480 ^BPSOSSG ( see SET CO DE in fiel d 480)
4309	"DATA",900 2313.91,24 0,30,0)
4310	^9002313.9 103^1^1^31 01006^^
4311	"DATA",900 2313.91,24 0,30,1,0)
4312	; fields 4 78, 479, 4 80 handled by FLD480 ^BPSOSSG ( see SET CO DE in fiel d 480)
4313	"DATA",900 2313.91,24 1,0)
4314	479^^OTHER AMT CLAIM ED SUBM QL FR^A/N^^^^ 2^A/N
4315	"DATA",900 2313.91,24 1,1)
4316	OTHER AMOU NT CLAIMED SUBMITTED QUALIFIER
4317	"DATA",900 2313.91,24 1,5)
4318	H8^2
4319	"DATA",900 2313.91,24 1,10,0)
4320	^9002313.9 101^1^1^31 01006^^^
4321	"DATA",900 2313.91,24 1,10,1,0)
4322	; fields 4 78, 479, 4 80 handled by FLD480 ^BPSOSSG ( see SET CO DE in fiel d 480)
4323	"DATA",900 2313.91,24 1,20,0)
4324	^9002313.9 102^1^1^31 01006^^^
4325	"DATA",900 2313.91,24 1,20,1,0)
4326	; fields 4 78, 479, 4 80 handled by FLD480 ^BPSOSSG ( see SET CO DE in fiel d 480)
4327	"DATA",900 2313.91,24 1,25,0)
4328	^9002313.9 104^1^1^31 01006^^
4329	"DATA",900 2313.91,24 1,25,1,0)
4330	; fields 4 78, 479, 4 80 handled by FLD480 ^BPSOSSG ( see SET CO DE in fiel d 480)
4331	"DATA",900 2313.91,24 1,30,0)
4332	^9002313.9 103^1^1^31 01006^^
4333	"DATA",900 2313.91,24 1,30,1,0)
4334	; fields 4 78, 479, 4 80 handled by FLD480 ^BPSOSSG ( see SET CO DE in fiel d 480)
4335	"DATA",900 2313.91,24 2,0)
4336	463^^INTER MEDIARY AU TH TYPE ID ^N^^^^2^N
4337	"DATA",900 2313.91,24 2,1)
4338	INTERMEDIA RY AUTHORI ZATION TYP E ID
4339	"DATA",900 2313.91,24 2,5)
4340	EW^2
4341	"DATA",900 2313.91,24 2,10,0)
4342	^^2^2^3110 727^
4343	"DATA",900 2313.91,24 2,10,1,0)
4344	S BPS("X") =$G(BPS("C laim",BPS( 9002313.02 01),"Inter mediary Au th Type ID "))
4345	"DATA",900 2313.91,24 2,10,2,0)
4346	S:BPS("X") ="" BPS("X ")=0
4347	"DATA",900 2313.91,24 2,20,0)
4348	^9002313.9 102^1^1^31 01101
4349	"DATA",900 2313.91,24 2,20,1,0)
4350	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
4351	"DATA",900 2313.91,24 2,25,0)
4352	^9002313.9 104^1^1^30 30823^^^^
4353	"DATA",900 2313.91,24 2,25,1,0)
4354	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
4355	"DATA",900 2313.91,24 2,30,0)
4356	^9002313.9 103^1^1^30 30823^^
4357	"DATA",900 2313.91,24 2,30,1,0)
4358	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 60),U,3)=B PS("X")
4359	"DATA",900 2313.91,26 5,0)
4360	451^^COMPO UND DISP U NIT FORM I NDCTR^N^^^ ^1^N
4361	"DATA",900 2313.91,26 5,1)
4362	COMPOUND D ISPENSING UNIT FORM INDICATOR
4363	"DATA",900 2313.91,26 5,5)
4364	EG^1
4365	"DATA",900 2313.91,26 5,10,0)
4366	^9002313.9 101^1^1^30 40224
4367	"DATA",900 2313.91,26 5,10,1,0)
4368	S BPS("X") =""
4369	"DATA",900 2313.91,26 5,20,0)
4370	^9002313.9 102^1^1^31 01101
4371	"DATA",900 2313.91,26 5,20,1,0)
4372	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
4373	"DATA",900 2313.91,26 5,25,0)
4374	^9002313.9 104^1^1^30 40224^^^^
4375	"DATA",900 2313.91,26 5,25,1,0)
4376	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
4377	"DATA",900 2313.91,26 6,0)
4378	450^^COMPO UND DOSAGE FORM DESC CODE^A/N^ ^^^15^A/N
4379	"DATA",900 2313.91,26 6,1)
4380	COMPOUND D OSAGE FORM DESCRIPTI ON CODE
4381	"DATA",900 2313.91,26 6,5)
4382	EF^15
4383	"DATA",900 2313.91,26 6,10,0)
4384	^9002313.9 101^1^1^31 01115^
4385	"DATA",900 2313.91,26 6,10,1,0)
4386	S BPS("X") =""
4387	"DATA",900 2313.91,26 6,20,0)
4388	^9002313.9 102^1^1^31 01101
4389	"DATA",900 2313.91,26 6,20,1,0)
4390	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4391	"DATA",900 2313.91,26 6,25,0)
4392	^9002313.9 104^1^1^30 40107^^^^
4393	"DATA",900 2313.91,26 6,25,1,0)
4394	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4395	"DATA",900 2313.91,26 6,30,0)
4396	^9002313.9 103^1^1^30 40107^^^^
4397	"DATA",900 2313.91,26 6,30,1,0)
4398	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 40),U,10)= BPS("X")
4399	"DATA",900 2313.91,26 7,0)
4400	490^^COMP INGRED BAS IS COST DE TERM^A/N^^ ^^2^A/N
4401	"DATA",900 2313.91,26 7,1)
4402	COMPOUND I NGREDIENT BASIS OF C OST DETERM INATION
4403	"DATA",900 2313.91,26 7,5)
4404	UE^2
4405	"DATA",900 2313.91,26 7,10,0)
4406	^9002313.9 101^1^1^30 40224
4407	"DATA",900 2313.91,26 7,10,1,0)
4408	S BPS("X") =""
4409	"DATA",900 2313.91,26 7,20,0)
4410	^9002313.9 102^1^1^31 01101
4411	"DATA",900 2313.91,26 7,20,1,0)
4412	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4413	"DATA",900 2313.91,26 7,25,0)
4414	^9002313.9 104^1^1^30 40224^^^^
4415	"DATA",900 2313.91,26 7,25,1,0)
4416	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4417	"DATA",900 2313.91,26 8,0)
4418	447^^COMPO UND INGRED IENT COMP COUNT^N^^^ ^2^N
4419	"DATA",900 2313.91,26 8,1)
4420	COMPOUND I NGREDIENT COMPONENT COUNT
4421	"DATA",900 2313.91,26 8,5)
4422	EC^2
4423	"DATA",900 2313.91,26 8,10,0)
4424	^9002313.9 101^1^1^31 01115^
4425	"DATA",900 2313.91,26 8,10,1,0)
4426	S BPS("X") =""
4427	"DATA",900 2313.91,26 8,20,0)
4428	^9002313.9 102^1^1^31 01101
4429	"DATA",900 2313.91,26 8,20,1,0)
4430	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
4431	"DATA",900 2313.91,26 8,25,0)
4432	^9002313.9 104^1^1^30 40107^^^^
4433	"DATA",900 2313.91,26 8,25,1,0)
4434	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
4435	"DATA",900 2313.91,26 8,30,0)
4436	^9002313.9 103^1^1^30 40107^^^^
4437	"DATA",900 2313.91,26 8,30,1,0)
4438	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),4 40),U,7)=B PS("X")
4439	"DATA",900 2313.91,26 9,0)
4440	449^^COMPO UND INGRED IENT DRUG COST^N^^^^ 8^D
4441	"DATA",900 2313.91,26 9,5)
4442	EE^8
4443	"DATA",900 2313.91,26 9,10,0)
4444	^9002313.9 101^1^1^30 40224
4445	"DATA",900 2313.91,26 9,10,1,0)
4446	S BPS("X") =""
4447	"DATA",900 2313.91,26 9,20,0)
4448	^9002313.9 102^1^1^31 01101
4449	"DATA",900 2313.91,26 9,20,1,0)
4450	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
4451	"DATA",900 2313.91,26 9,25,0)
4452	^9002313.9 104^1^1^30 40224^^^^
4453	"DATA",900 2313.91,26 9,25,1,0)
4454	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),8 )
4455	"DATA",900 2313.91,27 1,0)
4456	489^^COMPO UND PRODUC T ID^A/N^^ ^^19^A/N
4457	"DATA",900 2313.91,27 1,5)
4458	TE^19
4459	"DATA",900 2313.91,27 1,10,0)
4460	^9002313.9 101^1^1^30 40224
4461	"DATA",900 2313.91,27 1,10,1,0)
4462	S BPS("X") =""
4463	"DATA",900 2313.91,27 1,20,0)
4464	^9002313.9 102^1^1^31 01101
4465	"DATA",900 2313.91,27 1,20,1,0)
4466	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 9)
4467	"DATA",900 2313.91,27 1,25,0)
4468	^9002313.9 104^1^1^30 40224^^^^
4469	"DATA",900 2313.91,27 1,25,1,0)
4470	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 9)
4471	"DATA",900 2313.91,27 2,0)
4472	488^^COMPO UND PRODUC T ID QUALI FIER^A/N^^ ^^2^A/N
4473	"DATA",900 2313.91,27 2,5)
4474	RE^2
4475	"DATA",900 2313.91,27 2,10,0)
4476	^9002313.9 101^1^1^30 40224
4477	"DATA",900 2313.91,27 2,10,1,0)
4478	S BPS("X") =""
4479	"DATA",900 2313.91,27 2,20,0)
4480	^9002313.9 102^1^1^31 01101
4481	"DATA",900 2313.91,27 2,20,1,0)
4482	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4483	"DATA",900 2313.91,27 2,25,0)
4484	^9002313.9 104^1^1^30 40224^^^^
4485	"DATA",900 2313.91,27 2,25,1,0)
4486	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4487	"DATA",900 2313.91,27 3,0)
4488	452^^COMPO UND ROUTE OF ADMIN^N ^^^^2^N
4489	"DATA",900 2313.91,27 3,5)
4490	EH^2
4491	"DATA",900 2313.91,27 3,10,0)
4492	^9002313.9 101^1^1^30 40224
4493	"DATA",900 2313.91,27 3,10,1,0)
4494	S BPS("X") =""
4495	"DATA",900 2313.91,27 3,20,0)
4496	^9002313.9 102^1^1^31 01101
4497	"DATA",900 2313.91,27 3,20,1,0)
4498	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
4499	"DATA",900 2313.91,27 3,25,0)
4500	^9002313.9 104^1^1^30 40224^^^^
4501	"DATA",900 2313.91,27 3,25,1,0)
4502	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
4503	"DATA",900 2313.91,30 8,0)
4504	448^^COMPO UND INGRED IENT QUANT ITY^N^^^^1 0^N
4505	"DATA",900 2313.91,30 8,5)
4506	ED^10
4507	"DATA",900 2313.91,30 8,10,0)
4508	^9002313.9 101^1^1^30 40224
4509	"DATA",900 2313.91,30 8,10,1,0)
4510	S BPS("X") =""
4511	"DATA",900 2313.91,30 8,20,0)
4512	^9002313.9 102^1^1^31 01101
4513	"DATA",900 2313.91,30 8,20,1,0)
4514	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
4515	"DATA",900 2313.91,30 8,25,0)
4516	^9002313.9 104^1^1^30 40224^^^^
4517	"DATA",900 2313.91,30 8,25,1,0)
4518	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),10 )
4519	"DATA",900 2313.91,32 4,0)
4520	494^^MEASU REMENT DAT E^A/N^^^^8 ^N
4521	"DATA",900 2313.91,32 4,5)
4522	ZE^8
4523	"DATA",900 2313.91,32 4,10,0)
4524	^9002313.9 101^1^1^30 40224
4525	"DATA",900 2313.91,32 4,10,1,0)
4526	S BPS("X") =""
4527	"DATA",900 2313.91,32 4,20,0)
4528	^9002313.9 102^1^1^31 01101
4529	"DATA",900 2313.91,32 4,20,1,0)
4530	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
4531	"DATA",900 2313.91,32 4,25,0)
4532	^9002313.9 104^1^1^30 40224^
4533	"DATA",900 2313.91,32 4,25,1,0)
4534	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
4535	"DATA",900 2313.91,32 5,0)
4536	496^^MEASU REMENT DIM ENSION^A/N ^^^^2^A/N
4537	"DATA",900 2313.91,32 5,5)
4538	H2^2
4539	"DATA",900 2313.91,32 5,10,0)
4540	^9002313.9 101^1^1^30 40224
4541	"DATA",900 2313.91,32 5,10,1,0)
4542	S BPS("X") =""
4543	"DATA",900 2313.91,32 5,20,0)
4544	^9002313.9 102^1^1^31 01101
4545	"DATA",900 2313.91,32 5,20,1,0)
4546	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4547	"DATA",900 2313.91,32 5,25,0)
4548	^9002313.9 104^1^1^30 40224^^^^
4549	"DATA",900 2313.91,32 5,25,1,0)
4550	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4551	"DATA",900 2313.91,32 6,0)
4552	495^^MEASU REMENT TIM E^N^^^^4^N
4553	"DATA",900 2313.91,32 6,5)
4554	H1^4
4555	"DATA",900 2313.91,32 6,10,0)
4556	^9002313.9 101^1^1^30 40224
4557	"DATA",900 2313.91,32 6,10,1,0)
4558	S BPS("X") =""
4559	"DATA",900 2313.91,32 6,20,0)
4560	^9002313.9 102^1^1^31 01101
4561	"DATA",900 2313.91,32 6,20,1,0)
4562	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),4)
4563	"DATA",900 2313.91,32 6,25,0)
4564	^9002313.9 104^1^1^30 40224^^^^
4565	"DATA",900 2313.91,32 6,25,1,0)
4566	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),4)
4567	"DATA",900 2313.91,32 7,0)
4568	497^^MEASU REMENT UNI T^A/N^^^^2 ^A/N
4569	"DATA",900 2313.91,32 7,5)
4570	H3^2
4571	"DATA",900 2313.91,32 7,10,0)
4572	^9002313.9 101^1^1^30 40224
4573	"DATA",900 2313.91,32 7,10,1,0)
4574	S BPS("X") =""
4575	"DATA",900 2313.91,32 7,20,0)
4576	^9002313.9 102^1^1^31 01101
4577	"DATA",900 2313.91,32 7,20,1,0)
4578	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4579	"DATA",900 2313.91,32 7,25,0)
4580	^9002313.9 104^1^1^30 40224^^^^
4581	"DATA",900 2313.91,32 7,25,1,0)
4582	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4583	"DATA",900 2313.91,32 8,0)
4584	499^^MEASU REMENT VAL UE^A/N^^^^ 15^A/N
4585	"DATA",900 2313.91,32 8,5)
4586	H4^15
4587	"DATA",900 2313.91,32 8,10,0)
4588	^9002313.9 101^1^1^30 40224
4589	"DATA",900 2313.91,32 8,10,1,0)
4590	S BPS("X") =""
4591	"DATA",900 2313.91,32 8,20,0)
4592	^9002313.9 102^1^1^31 01101
4593	"DATA",900 2313.91,32 8,20,1,0)
4594	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
4595	"DATA",900 2313.91,32 8,25,0)
4596	^9002313.9 104^1^1^30 40224^^^
4597	"DATA",900 2313.91,32 8,25,1,0)
4598	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
4599	"DATA",900 2313.91,32 9,0)
4600	990^^OTHER PAYER BIN NUMBER^N^ ^^^6^N
4601	"DATA",900 2313.91,32 9,5)
4602	MG^6
4603	"DATA",900 2313.91,32 9,10,0)
4604	^9002313.9 101^1^1^31 01101
4605	"DATA",900 2313.91,32 9,10,1,0)
4606	S BPS("X") =""
4607	"DATA",900 2313.91,32 9,20,0)
4608	^9002313.9 102^1^1^31 01101
4609	"DATA",900 2313.91,32 9,20,1,0)
4610	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),6)
4611	"DATA",900 2313.91,32 9,30,0)
4612	^9002313.9 103^1^1^31 01101^
4613	"DATA",900 2313.91,32 9,30,1,0)
4614	S $P(^BPSC (BPS(90023 13.02),980 ),U,10)=""
4615	"DATA",900 2313.91,33 0,0)
4616	991^^OTHER PAYER PRO C CONTROL NUM^A/N^^^ ^10^A/N
4617	"DATA",900 2313.91,33 0,1)
4618	OTHER PAYE R PROCESSO R CONTROL NUMBER
4619	"DATA",900 2313.91,33 0,5)
4620	MH^10
4621	"DATA",900 2313.91,33 0,10,0)
4622	^9002313.9 101^1^1^31 01101
4623	"DATA",900 2313.91,33 0,10,1,0)
4624	S BPS("X") =""
4625	"DATA",900 2313.91,33 0,20,0)
4626	^9002313.9 102^1^1^31 01101
4627	"DATA",900 2313.91,33 0,20,1,0)
4628	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0)
4629	"DATA",900 2313.91,33 0,30,0)
4630	^9002313.9 103^1^1^31 01101^^
4631	"DATA",900 2313.91,33 0,30,1,0)
4632	S $P(^BPSC (BPS(90023 13.02),990 ),U,1)=""
4633	"DATA",900 2313.91,33 1,0)
4634	356^^OTHER PAYER CAR DHOLDER ID ^A/N^^^^20 ^A/N
4635	"DATA",900 2313.91,33 1,5)
4636	NU^20
4637	"DATA",900 2313.91,33 1,10,0)
4638	^9002313.9 101^1^1^31 01101
4639	"DATA",900 2313.91,33 1,10,1,0)
4640	S BPS("X") =""
4641	"DATA",900 2313.91,33 1,20,0)
4642	^9002313.9 102^1^1^31 01101
4643	"DATA",900 2313.91,33 1,20,1,0)
4644	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
4645	"DATA",900 2313.91,33 1,30,0)
4646	^9002313.9 103^1^1^31 01101^^
4647	"DATA",900 2313.91,33 1,30,1,0)
4648	S $P(^BPSC (BPS(90023 13.02),350 ),U,6)=""
4649	"DATA",900 2313.91,33 2,0)
4650	992^^OTHER PAYER GRO UP ID^A/N^ ^^^15^A/N
4651	"DATA",900 2313.91,33 2,5)
4652	MJ^15
4653	"DATA",900 2313.91,33 2,10,0)
4654	^9002313.9 101^1^1^31 01101
4655	"DATA",900 2313.91,33 2,10,1,0)
4656	S BPS("X") =""
4657	"DATA",900 2313.91,33 2,20,0)
4658	^9002313.9 102^1^1^31 01101
4659	"DATA",900 2313.91,33 2,20,1,0)
4660	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
4661	"DATA",900 2313.91,33 2,30,0)
4662	^9002313.9 103^1^1^31 01101^^
4663	"DATA",900 2313.91,33 2,30,1,0)
4664	S $P(^BPSC (BPS(90023 13.02),990 ),U,2)=""
4665	"DATA",900 2313.91,33 3,0)
4666	359^^MEDIG AP ID^A/N^ ^^^20^A/N
4667	"DATA",900 2313.91,33 3,5)
4668	2A^20
4669	"DATA",900 2313.91,33 3,10,0)
4670	^9002313.9 101^1^1^31 01101
4671	"DATA",900 2313.91,33 3,10,1,0)
4672	S BPS("X") =""
4673	"DATA",900 2313.91,33 3,20,0)
4674	^9002313.9 102^1^1^31 01101
4675	"DATA",900 2313.91,33 3,20,1,0)
4676	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
4677	"DATA",900 2313.91,33 3,30,0)
4678	^9002313.9 103^1^1^31 00923^^
4679	"DATA",900 2313.91,33 3,30,1,0)
4680	S $P(^BPSC (BPS(90023 13.02),350 ),U,9)=""
4681	"DATA",900 2313.91,33 4,0)
4682	360^^MEDIC AID INDICA TOR^N^^^^2 ^A/N
4683	"DATA",900 2313.91,33 4,5)
4684	2B^2
4685	"DATA",900 2313.91,33 4,10,0)
4686	^9002313.9 101^1^1^31 01101
4687	"DATA",900 2313.91,33 4,10,1,0)
4688	S BPS("X") =""
4689	"DATA",900 2313.91,33 4,20,0)
4690	^9002313.9 102^1^1^31 01101
4691	"DATA",900 2313.91,33 4,20,1,0)
4692	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4693	"DATA",900 2313.91,33 4,30,0)
4694	^9002313.9 103^1^1^31 01101^
4695	"DATA",900 2313.91,33 4,30,1,0)
4696	S $P(^BPSC (BPS(90023 13.02),350 ),U,10)=""
4697	"DATA",900 2313.91,33 5,0)
4698	361^^PROVI DER ACCEPT ASSGNMT I NDCTR^A/N^ ^^^1^A/N
4699	"DATA",900 2313.91,33 5,1)
4700	PROVIDER A CCEPT ASSI GNMENT IND ICATOR
4701	"DATA",900 2313.91,33 5,5)
4702	2D^1
4703	"DATA",900 2313.91,33 5,10,0)
4704	^9002313.9 101^1^1^31 01101
4705	"DATA",900 2313.91,33 5,10,1,0)
4706	S BPS("X") ="Y"
4707	"DATA",900 2313.91,33 5,20,0)
4708	^9002313.9 102^1^1^31 01101
4709	"DATA",900 2313.91,33 5,20,1,0)
4710	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
4711	"DATA",900 2313.91,33 5,30,0)
4712	^9002313.9 103^1^1^31 01101^^
4713	"DATA",900 2313.91,33 5,30,1,0)
4714	S $P(^BPSC (BPS(90023 13.02),360 ),U,1)=$G( BPS("X"))
4715	"DATA",900 2313.91,33 6,0)
4716	997^^CMS P ART D DEFN D QLFD FAC ILITY^A/N^ ^^^1^A/N
4717	"DATA",900 2313.91,33 6,1)
4718	CMS PART D DEFINED Q UALIFIED F ACILITY
4719	"DATA",900 2313.91,33 6,5)
4720	G2^1
4721	"DATA",900 2313.91,33 6,10,0)
4722	^9002313.9 101^1^1^31 01101
4723	"DATA",900 2313.91,33 6,10,1,0)
4724	S BPS("X") ="N"
4725	"DATA",900 2313.91,33 6,20,0)
4726	^9002313.9 102^1^1^31 01101
4727	"DATA",900 2313.91,33 6,20,1,0)
4728	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
4729	"DATA",900 2313.91,33 6,30,0)
4730	^9002313.9 103^1^1^31 01101^^
4731	"DATA",900 2313.91,33 6,30,1,0)
4732	S $P(^BPSC (BPS(90023 13.02),990 ),U,7)=$G( BPS("X"))
4733	"DATA",900 2313.91,33 7,0)
4734	115^^MEDIC AID ID NUM BER^A/N^^^ ^20^A/N
4735	"DATA",900 2313.91,33 7,5)
4736	N5^20
4737	"DATA",900 2313.91,33 7,10,0)
4738	^9002313.9 101^1^1^31 01101
4739	"DATA",900 2313.91,33 7,10,1,0)
4740	S BPS("X") =""
4741	"DATA",900 2313.91,33 7,20,0)
4742	^9002313.9 102^1^1^31 01101
4743	"DATA",900 2313.91,33 7,20,1,0)
4744	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
4745	"DATA",900 2313.91,33 7,30,0)
4746	^9002313.9 103^1^1^31 01206^
4747	"DATA",900 2313.91,33 7,30,1,0)
4748	S $P(^BPSC (BPS(90023 13.02),110 ),U,5)=""
4749	"DATA",900 2313.91,33 8,0)
4750	116^^MEDIC AID AGENCY NUMBER^A/ N^^^^15^A/ N
4751	"DATA",900 2313.91,33 8,5)
4752	N6^15
4753	"DATA",900 2313.91,33 8,10,0)
4754	^9002313.9 101^1^1^31 01101
4755	"DATA",900 2313.91,33 8,10,1,0)
4756	S BPS("X") =""
4757	"DATA",900 2313.91,33 8,20,0)
4758	^9002313.9 102^1^1^31 01101
4759	"DATA",900 2313.91,33 8,20,1,0)
4760	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
4761	"DATA",900 2313.91,33 8,30,0)
4762	^9002313.9 103^1^1^31 01206^
4763	"DATA",900 2313.91,33 8,30,1,0)
4764	S $P(^BPSC (BPS(90023 13.02),110 ),U,6)=""
4765	"DATA",900 2313.91,33 9,0)
4766	384^^PATIE NT RESIDEN CE^N^^^^2^ N
4767	"DATA",900 2313.91,33 9,5)
4768	4X^2
4769	"DATA",900 2313.91,33 9,10,0)
4770	^9002313.9 101^1^1^31 01101
4771	"DATA",900 2313.91,33 9,10,1,0)
4772	S BPS("X") =$G(BPS("P atient","P atient Res idence"))
4773	"DATA",900 2313.91,33 9,20,0)
4774	^9002313.9 102^1^1^31 01101
4775	"DATA",900 2313.91,33 9,20,1,0)
4776	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
4777	"DATA",900 2313.91,33 9,30,0)
4778	^9002313.9 103^1^1^31 01007^^^^
4779	"DATA",900 2313.91,33 9,30,1,0)
4780	S $P(^BPSC (BPS(90023 13.02),380 ),U,4)=$G( BPS("X"))
4781	"DATA",900 2313.91,34 0,0)
4782	354^^SUBMI SSION CLAR IF CODE CO UNT^N^^^^1 ^N
4783	"DATA",900 2313.91,34 0,1)
4784	SUBMISSION CLARIFICA TION CODE COUNT
4785	"DATA",900 2313.91,34 0,5)
4786	NX^2
4787	"DATA",900 2313.91,34 0,10,0)
4788	^9002313.9 101^1^1^31 01006^^
4789	"DATA",900 2313.91,34 0,10,1,0)
4790	; fields 3 54 & 420 h andled by FLD420^BPS OSSG (see SET CODE i n field 42 0)
4791	"DATA",900 2313.91,34 0,20,0)
4792	^9002313.9 102^1^1^31 01006^^
4793	"DATA",900 2313.91,34 0,20,1,0)
4794	; fields 3 54 & 420 h andled by FLD420^BPS OSSG (see SET CODE i n field 42 0)
4795	"DATA",900 2313.91,34 0,25,0)
4796	^9002313.9 104^1^1^31 01006^^
4797	"DATA",900 2313.91,34 0,25,1,0)
4798	; fields 3 54 & 420 h andled by FLD420^BPS OSSG (see SET CODE i n field 42 0)
4799	"DATA",900 2313.91,34 0,30,0)
4800	^9002313.9 103^1^1^31 01006^^^^
4801	"DATA",900 2313.91,34 0,30,1,0)
4802	; fields 3 54 & 420 h andled by FLD420^BPS OSSG (see SET CODE i n field 42 0)
4803	"DATA",900 2313.91,34 1,0)
4804	357^^DELAY REASON CO DE^N^^^^2^ N
4805	"DATA",900 2313.91,34 1,5)
4806	NV^2
4807	"DATA",900 2313.91,34 1,10,0)
4808	^9002313.9 101^1^1^31 01007^^
4809	"DATA",900 2313.91,34 1,10,1,0)
4810	S BPS("X") =$G(BPS("C laim",BPS( 9002313.02 01),"Delay Reason Co de"))
4811	"DATA",900 2313.91,34 1,20,0)
4812	^9002313.9 102^1^1^31 01012^
4813	"DATA",900 2313.91,34 1,20,1,0)
4814	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
4815	"DATA",900 2313.91,34 1,30,0)
4816	^9002313.9 103^1^1^31 01007^^
4817	"DATA",900 2313.91,34 1,30,1,0)
4818	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 50),U,7)=$ S($G(BPS(" X"))="NV00 ":"",1:$G( BPS("X")))
4819	"DATA",900 2313.91,34 2,0)
4820	880^^TRANS ACTION REF ERENCE NUM BER^A/N^^^ ^10^A/N
4821	"DATA",900 2313.91,34 2,5)
4822	K5^10
4823	"DATA",900 2313.91,34 2,10,0)
4824	^9002313.9 101^1^1^31 01101
4825	"DATA",900 2313.91,34 2,10,1,0)
4826	S BPS("X") =""
4827	"DATA",900 2313.91,34 2,20,0)
4828	^9002313.9 102^1^1^31 01101
4829	"DATA",900 2313.91,34 2,20,1,0)
4830	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0)
4831	"DATA",900 2313.91,34 2,30,0)
4832	^9002313.9 103^1^1^31 01206^
4833	"DATA",900 2313.91,34 2,30,1,0)
4834	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),8 70),U,10)= ""
4835	"DATA",900 2313.91,34 3,0)
4836	391^^PATIE NT ASSIGNM ENT INDICA TOR^A/N^^^ ^1^A/N
4837	"DATA",900 2313.91,34 3,1)
4838	PATIENT AS SIGNMENT I NDICATOR ( DIRECT MEM BER REIMBU RSEMENT IN DICATOR)
4839	"DATA",900 2313.91,34 3,5)
4840	MT^1
4841	"DATA",900 2313.91,34 3,10,0)
4842	^9002313.9 101^1^1^31 01101
4843	"DATA",900 2313.91,34 3,10,1,0)
4844	S BPS("X") ="Y"
4845	"DATA",900 2313.91,34 3,20,0)
4846	^9002313.9 102^1^1^31 01101
4847	"DATA",900 2313.91,34 3,20,1,0)
4848	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
4849	"DATA",900 2313.91,34 3,30,0)
4850	^9002313.9 103^1^1^31 01101^^
4851	"DATA",900 2313.91,34 3,30,1,0)
4852	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 90),U,1)=$ G(BPS("X") )
4853	"DATA",900 2313.91,34 4,0)
4854	995^^ROUTE OF ADMINI STRATION^A /N^^^^11^A /N
4855	"DATA",900 2313.91,34 4,5)
4856	E2^1
4857	"DATA",900 2313.91,34 4,10,0)
4858	^9002313.9 101^1^1^31 01101
4859	"DATA",900 2313.91,34 4,10,1,0)
4860	S BPS("X") =""
4861	"DATA",900 2313.91,34 4,20,0)
4862	^9002313.9 102^1^1^31 01101
4863	"DATA",900 2313.91,34 4,20,1,0)
4864	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 1)
4865	"DATA",900 2313.91,34 4,30,0)
4866	^9002313.9 103^1^1^31 01101^^
4867	"DATA",900 2313.91,34 4,30,1,0)
4868	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),9 90),U,5)=$ G(BPS("X") )
4869	"DATA",900 2313.91,34 5,0)
4870	996^^COMPO UND TYPE^A /N^^^^2^A/ N
4871	"DATA",900 2313.91,34 5,5)
4872	G1^2
4873	"DATA",900 2313.91,34 5,10,0)
4874	^9002313.9 101^1^1^31 01206^
4875	"DATA",900 2313.91,34 5,10,1,0)
4876	S BPS("X") =""
4877	"DATA",900 2313.91,34 5,20,0)
4878	^9002313.9 102^1^1^31 01206^
4879	"DATA",900 2313.91,34 5,20,1,0)
4880	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4881	"DATA",900 2313.91,34 5,30,0)
4882	^^1^1^3121 128
4883	"DATA",900 2313.91,34 5,30,1,0)
4884	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),9 90),U,6)=" "
4885	"DATA",900 2313.91,34 6,0)
4886	114^^MEDIC AID SUBROG ATION ICN/ TCN^A/N^^^ ^20^A/N
4887	"DATA",900 2313.91,34 6,1)
4888	MEDICAID S UBROGATION INTERNAL CONTROL NU MBER/TRANS ACTION CON TROL NUMBE R (ICN/TCN )
4889	"DATA",900 2313.91,34 6,5)
4890	N4^20
4891	"DATA",900 2313.91,34 6,10,0)
4892	^9002313.9 101^1^1^31 01110^
4893	"DATA",900 2313.91,34 6,10,1,0)
4894	S BPS("X") =""
4895	"DATA",900 2313.91,34 6,20,0)
4896	^9002313.9 102^1^1^31 01110^
4897	"DATA",900 2313.91,34 6,20,1,0)
4898	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
4899	"DATA",900 2313.91,34 6,30,0)
4900	^9002313.9 103^1^1^31 01206^
4901	"DATA",900 2313.91,34 6,30,1,0)
4902	S $P(^BPSC (BPS(90023 13.02),110 ),U,4)=""
4903	"DATA",900 2313.91,34 7,0)
4904	147^^PHARM ACY SERVIC E TYPE^N^^ ^^2^N
4905	"DATA",900 2313.91,34 7,5)
4906	U7^2
4907	"DATA",900 2313.91,34 7,10,0)
4908	^9002313.9 101^1^1^31 01007^^
4909	"DATA",900 2313.91,34 7,10,1,0)
4910	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Pharmacy Service T ype"))
4911	"DATA",900 2313.91,34 7,20,0)
4912	^9002313.9 102^1^1^31 01007^^
4913	"DATA",900 2313.91,34 7,20,1,0)
4914	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
4915	"DATA",900 2313.91,34 7,30,0)
4916	^9002313.9 103^1^1^31 01007^^^^
4917	"DATA",900 2313.91,34 7,30,1,0)
4918	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),1 40),U,7)=$ G(BPS("X") )
4919	"DATA",900 2313.91,34 8,0)
4920	364^^PRESC RIBER FIRS T NAME^A/N ^^^^12^A/N
4921	"DATA",900 2313.91,34 8,5)
4922	2J^12
4923	"DATA",900 2313.91,34 8,10,0)
4924	^9002313.9 101^1^1^31 01029^
4925	"DATA",900 2313.91,34 8,10,1,0)
4926	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Prescrib er First N ame"))
4927	"DATA",900 2313.91,34 8,20,0)
4928	^9002313.9 102^1^1^31 01101
4929	"DATA",900 2313.91,34 8,20,1,0)
4930	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 2)
4931	"DATA",900 2313.91,34 8,30,0)
4932	^9002313.9 103^1^1^31 01101^^^
4933	"DATA",900 2313.91,34 8,30,1,0)
4934	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 60),U,4)=$ G(BPS("X") )
4935	"DATA",900 2313.91,34 9,0)
4936	365^^PRESC RIBER STRE ET ADDRESS ^A/N^^^^30 ^A/N
4937	"DATA",900 2313.91,34 9,5)
4938	2K^30
4939	"DATA",900 2313.91,34 9,10,0)
4940	^9002313.9 101^1^1^31 01029^
4941	"DATA",900 2313.91,34 9,10,1,0)
4942	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Prescrib er Street Address"))
4943	"DATA",900 2313.91,34 9,20,0)
4944	^9002313.9 102^1^1^31 01101
4945	"DATA",900 2313.91,34 9,20,1,0)
4946	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
4947	"DATA",900 2313.91,34 9,30,0)
4948	^9002313.9 103^1^1^31 01101^^
4949	"DATA",900 2313.91,34 9,30,1,0)
4950	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 60),U,5)=$ G(BPS("X") )
4951	"DATA",900 2313.91,35 0,0)
4952	366^^PRESC RIBER CITY ADDRESS^A /N^^^^20^A /N
4953	"DATA",900 2313.91,35 0,5)
4954	2M^20
4955	"DATA",900 2313.91,35 0,10,0)
4956	^9002313.9 101^1^1^31 01029^
4957	"DATA",900 2313.91,35 0,10,1,0)
4958	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Prescrib er City Ad dress"))
4959	"DATA",900 2313.91,35 0,20,0)
4960	^9002313.9 102^1^1^31 01101
4961	"DATA",900 2313.91,35 0,20,1,0)
4962	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
4963	"DATA",900 2313.91,35 0,30,0)
4964	^9002313.9 103^1^1^31 01101^^
4965	"DATA",900 2313.91,35 0,30,1,0)
4966	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 60),U,6)=$ G(BPS("X") )
4967	"DATA",900 2313.91,35 1,0)
4968	367^^PRESC RIBER STAT E/PROV ADD RESS^A/N^^ ^^2^A/N
4969	"DATA",900 2313.91,35 1,1)
4970	PRESCRIBER STATE/PRO VINCE ADDR ESS
4971	"DATA",900 2313.91,35 1,5)
4972	2N^2
4973	"DATA",900 2313.91,35 1,10,0)
4974	^9002313.9 101^1^1^31 01029^^
4975	"DATA",900 2313.91,35 1,10,1,0)
4976	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Prescrib er State/P rovince Ad dress"))
4977	"DATA",900 2313.91,35 1,20,0)
4978	^9002313.9 102^1^1^31 01101
4979	"DATA",900 2313.91,35 1,20,1,0)
4980	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
4981	"DATA",900 2313.91,35 1,30,0)
4982	^9002313.9 103^1^1^31 01101^^^
4983	"DATA",900 2313.91,35 1,30,1,0)
4984	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 60),U,7)=$ G(BPS("X") )
4985	"DATA",900 2313.91,35 2,0)
4986	368^^PRESC RIBER ZIP/ POSTAL ZON E^A/N^^^^1 5^A/N
4987	"DATA",900 2313.91,35 2,5)
4988	2P^2
4989	"DATA",900 2313.91,35 2,10,0)
4990	^9002313.9 101^1^1^31 01029^
4991	"DATA",900 2313.91,35 2,10,1,0)
4992	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Prescrib er Zip/Pos tal Zone") )
4993	"DATA",900 2313.91,35 2,20,0)
4994	^9002313.9 102^1^1^31 01101
4995	"DATA",900 2313.91,35 2,20,1,0)
4996	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
4997	"DATA",900 2313.91,35 2,30,0)
4998	^9002313.9 103^1^1^31 01101^^
4999	"DATA",900 2313.91,35 2,30,1,0)
5000	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 60),U,8)=$ G(BPS("X") )
5001	"DATA",900 2313.91,35 3,0)
5002	993^^INTER NAL CONTRO L NUMBER^A /N^^^^30^A /N
5003	"DATA",900 2313.91,35 3,5)
5004	A7^30
5005	"DATA",900 2313.91,35 3,10,0)
5006	^9002313.9 101^1^1^31 01101
5007	"DATA",900 2313.91,35 3,10,1,0)
5008	S BPS("X") =""
5009	"DATA",900 2313.91,35 3,20,0)
5010	^9002313.9 102^1^1^31 01101
5011	"DATA",900 2313.91,35 3,20,1,0)
5012	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
5013	"DATA",900 2313.91,35 3,30,0)
5014	^9002313.9 103^1^1^31 01029^
5015	"DATA",900 2313.91,35 3,30,1,0)
5016	; This fie ld current ly not imp lemented
5017	"DATA",900 2313.91,35 4,0)
5018	392^^BENEF IT STAGE C OUNT^N^^^^ 1^N
5019	"DATA",900 2313.91,35 4,5)
5020	MU^1
5021	"DATA",900 2313.91,35 4,10,0)
5022	^^1^1^3110 727^
5023	"DATA",900 2313.91,35 4,10,1,0)
5024	;GET code for this C OB field i s executed in COB^BP SOSHF
5025	"DATA",900 2313.91,35 4,20,0)
5026	^9002313.9 102^1^1^31 01101
5027	"DATA",900 2313.91,35 4,20,1,0)
5028	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
5029	"DATA",900 2313.91,35 4,30,0)
5030	^^1^1^3110 727^
5031	"DATA",900 2313.91,35 4,30,1,0)
5032	D SET392^B PSFLD01
5033	"DATA",900 2313.91,35 5,0)
5034	393^^BENEF IT STAGE Q UALIFIER^A /N^^^^2^A/ N
5035	"DATA",900 2313.91,35 5,5)
5036	MV^2
5037	"DATA",900 2313.91,35 5,10,0)
5038	^^1^1^3110 727^
5039	"DATA",900 2313.91,35 5,10,1,0)
5040	;GET code for this C OB field i s executed in COB^BP SOSHF
5041	"DATA",900 2313.91,35 5,20,0)
5042	^9002313.9 102^1^1^31 01101
5043	"DATA",900 2313.91,35 5,20,1,0)
5044	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
5045	"DATA",900 2313.91,35 5,30,0)
5046	^^1^1^3110 727^
5047	"DATA",900 2313.91,35 5,30,1,0)
5048	D SET393^B PSFLD01
5049	"DATA",900 2313.91,35 6,0)
5050	394^^BENEF IT STAGE A MOUNT^N^^^ ^8^D
5051	"DATA",900 2313.91,35 6,5)
5052	MW^8
5053	"DATA",900 2313.91,35 6,10,0)
5054	^^1^1^3110 727^
5055	"DATA",900 2313.91,35 6,10,1,0)
5056	;GET code for this C OB field i s executed in COB^BP SOSHF
5057	"DATA",900 2313.91,35 6,20,0)
5058	^9002313.9 102^1^1^31 01101
5059	"DATA",900 2313.91,35 6,20,1,0)
5060	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
5061	"DATA",900 2313.91,35 6,30,0)
5062	^^1^1^3110 727^
5063	"DATA",900 2313.91,35 6,30,1,0)
5064	D SET394^B PSFLD01
5065	"DATA",900 2313.91,35 7,0)
5066	117^^BILLI NG ENTITY TYPE INDIC ATOR^N^^^^ 2^N
5067	"DATA",900 2313.91,35 7,5)
5068	TR^2
5069	"DATA",900 2313.91,35 7,10,0)
5070	^9002313.9 101^1^1^31 01101
5071	"DATA",900 2313.91,35 7,10,1,0)
5072	S BPS("X") =""
5073	"DATA",900 2313.91,35 7,20,0)
5074	^9002313.9 102^1^1^31 01101
5075	"DATA",900 2313.91,35 7,20,1,0)
5076	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
5077	"DATA",900 2313.91,35 7,30,0)
5078	^9002313.9 103^1^1^31 00924^
5079	"DATA",900 2313.91,35 7,30,1,0)
5080	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),1 10),U,7)=" "
5081	"DATA",900 2313.91,35 8,0)
5082	118^^PAY T O QUALIFIE R^A/N^^^^2 ^A/N
5083	"DATA",900 2313.91,35 8,5)
5084	TS^2
5085	"DATA",900 2313.91,35 8,10,0)
5086	^9002313.9 101^1^1^31 01101
5087	"DATA",900 2313.91,35 8,10,1,0)
5088	S BPS("X") =""
5089	"DATA",900 2313.91,35 8,20,0)
5090	^9002313.9 102^1^1^31 01101
5091	"DATA",900 2313.91,35 8,20,1,0)
5092	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
5093	"DATA",900 2313.91,35 8,30,0)
5094	^9002313.9 103^1^1^31 00924^
5095	"DATA",900 2313.91,35 8,30,1,0)
5096	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),1 10),U,8)=" "
5097	"DATA",900 2313.91,35 9,0)
5098	119^^PAY T O ID^A/N^^ ^^15^A/N
5099	"DATA",900 2313.91,35 9,5)
5100	TT^15
5101	"DATA",900 2313.91,35 9,10,0)
5102	^9002313.9 101^1^1^31 01101
5103	"DATA",900 2313.91,35 9,10,1,0)
5104	S BPS("X") =""
5105	"DATA",900 2313.91,35 9,20,0)
5106	^9002313.9 102^1^1^31 01101
5107	"DATA",900 2313.91,35 9,20,1,0)
5108	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
5109	"DATA",900 2313.91,35 9,30,0)
5110	^9002313.9 103^1^1^31 00924^
5111	"DATA",900 2313.91,35 9,30,1,0)
5112	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),1 10),U,9)=" "
5113	"DATA",900 2313.91,36 0,0)
5114	120^^PAY T O NAME^A/N ^^^^20^A/N
5115	"DATA",900 2313.91,36 0,5)
5116	TU^20
5117	"DATA",900 2313.91,36 0,10,0)
5118	^9002313.9 101^1^1^31 01101
5119	"DATA",900 2313.91,36 0,10,1,0)
5120	S BPS("X") =""
5121	"DATA",900 2313.91,36 0,20,0)
5122	^9002313.9 102^1^1^31 01101
5123	"DATA",900 2313.91,36 0,20,1,0)
5124	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
5125	"DATA",900 2313.91,36 0,30,0)
5126	^9002313.9 103^1^1^31 00924^
5127	"DATA",900 2313.91,36 0,30,1,0)
5128	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),1 10),U,10)= ""
5129	"DATA",900 2313.91,36 1,0)
5130	121^^PAY T O STREET A DDRESS^A/N ^^^^30^A/N
5131	"DATA",900 2313.91,36 1,5)
5132	TV^30
5133	"DATA",900 2313.91,36 1,10,0)
5134	^9002313.9 101^1^1^31 01101
5135	"DATA",900 2313.91,36 1,10,1,0)
5136	S BPS("X") =""
5137	"DATA",900 2313.91,36 1,20,0)
5138	^9002313.9 102^1^1^31 01101
5139	"DATA",900 2313.91,36 1,20,1,0)
5140	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
5141	"DATA",900 2313.91,36 1,30,0)
5142	^9002313.9 103^1^1^31 00924^
5143	"DATA",900 2313.91,36 1,30,1,0)
5144	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),1 20),U,1)=" "
5145	"DATA",900 2313.91,36 2,0)
5146	122^^PAY T O CITY ADD RESS^A/N^^ ^^20^A/N
5147	"DATA",900 2313.91,36 2,5)
5148	TW^20
5149	"DATA",900 2313.91,36 2,10,0)
5150	^9002313.9 101^1^1^31 01101
5151	"DATA",900 2313.91,36 2,10,1,0)
5152	S BPS("X") =""
5153	"DATA",900 2313.91,36 2,20,0)
5154	^9002313.9 102^1^1^31 01101
5155	"DATA",900 2313.91,36 2,20,1,0)
5156	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
5157	"DATA",900 2313.91,36 2,30,0)
5158	^9002313.9 103^1^1^31 00924^
5159	"DATA",900 2313.91,36 2,30,1,0)
5160	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),1 20),U,2)=" "
5161	"DATA",900 2313.91,36 3,0)
5162	124^^PAY T O ZIP/POST AL ZONE^A/ N^^^^15^A/ N
5163	"DATA",900 2313.91,36 3,5)
5164	TY^15
5165	"DATA",900 2313.91,36 3,10,0)
5166	^9002313.9 101^1^1^31 01101
5167	"DATA",900 2313.91,36 3,10,1,0)
5168	S BPS("X") =""
5169	"DATA",900 2313.91,36 3,20,0)
5170	^9002313.9 102^1^1^31 01101
5171	"DATA",900 2313.91,36 3,20,1,0)
5172	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
5173	"DATA",900 2313.91,36 3,30,0)
5174	^9002313.9 103^1^1^31 00924^
5175	"DATA",900 2313.91,36 3,30,1,0)
5176	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),1 20),U,4)=" "
5177	"DATA",900 2313.91,36 4,0)
5178	125^^GENER IC EQUIV P ROD ID QLF R^A/N^^^^2 ^A/N
5179	"DATA",900 2313.91,36 4,1)
5180	GENERIC EQ UIVALENT P RODUCT ID QUALIFIER
5181	"DATA",900 2313.91,36 4,5)
5182	TZ^2
5183	"DATA",900 2313.91,36 4,10,0)
5184	^9002313.9 101^1^1^31 01101
5185	"DATA",900 2313.91,36 4,10,1,0)
5186	S BPS("X") =""
5187	"DATA",900 2313.91,36 4,20,0)
5188	^9002313.9 102^1^1^31 01101
5189	"DATA",900 2313.91,36 4,20,1,0)
5190	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
5191	"DATA",900 2313.91,36 4,30,0)
5192	^9002313.9 103^1^1^31 00924^
5193	"DATA",900 2313.91,36 4,30,1,0)
5194	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),1 20),U,5)=" "
5195	"DATA",900 2313.91,36 5,0)
5196	126^^GENER IC EQUIVAL ENT PRODUC T ID^A/N^^ ^^19^A/N
5197	"DATA",900 2313.91,36 5,5)
5198	UA^19
5199	"DATA",900 2313.91,36 5,10,0)
5200	^9002313.9 101^1^1^31 01101
5201	"DATA",900 2313.91,36 5,10,1,0)
5202	S BPS("X") =""
5203	"DATA",900 2313.91,36 5,20,0)
5204	^9002313.9 102^1^1^31 01101
5205	"DATA",900 2313.91,36 5,20,1,0)
5206	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 9)
5207	"DATA",900 2313.91,36 5,30,0)
5208	^9002313.9 103^1^1^31 00924^
5209	"DATA",900 2313.91,36 5,30,1,0)
5210	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),1 20),U,6)=" "
5211	"DATA",900 2313.91,36 6,0)
5212	113^^MEDIC AID PAID A MOUNT^N^^^ ^8^D
5213	"DATA",900 2313.91,36 6,5)
5214	N3^8
5215	"DATA",900 2313.91,36 6,10,0)
5216	^9002313.9 101^1^1^31 01101
5217	"DATA",900 2313.91,36 6,10,1,0)
5218	S BPS("X") =""
5219	"DATA",900 2313.91,36 6,20,0)
5220	^9002313.9 102^1^1^31 01101
5221	"DATA",900 2313.91,36 6,20,1,0)
5222	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),8)
5223	"DATA",900 2313.91,36 6,30,0)
5224	^9002313.9 103^1^1^31 00924^
5225	"DATA",900 2313.91,36 6,30,1,0)
5226	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),1 10),U,3)=" "
5227	"DATA",900 2313.91,36 7,0)
5228	362^^COMPO UND INGRED MOD CODE CNT^N^^^^2 ^N
5229	"DATA",900 2313.91,36 7,1)
5230	COMPOUND I NGREDIENT MODIFIER C ODE COUNT
5231	"DATA",900 2313.91,36 7,5)
5232	2G^2
5233	"DATA",900 2313.91,36 7,10,0)
5234	^9002313.9 101^1^1^31 01101
5235	"DATA",900 2313.91,36 7,10,1,0)
5236	S BPS("X") =""
5237	"DATA",900 2313.91,36 7,20,0)
5238	^9002313.9 102^1^1^31 01101
5239	"DATA",900 2313.91,36 7,20,1,0)
5240	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
5241	"DATA",900 2313.91,36 7,30,0)
5242	^9002313.9 103^1^1^31 01206^
5243	"DATA",900 2313.91,36 7,30,1,0)
5244	; This fie ld current ly not imp lemented
5245	"DATA",900 2313.91,36 8,0)
5246	363^^COMPO UND INGRED MODIFIER CODE^A/N^^ ^^2^A/N
5247	"DATA",900 2313.91,36 8,1)
5248	COMPOUND I NGREDIENT MODIFIER C ODE
5249	"DATA",900 2313.91,36 8,5)
5250	2H^2
5251	"DATA",900 2313.91,36 8,10,0)
5252	^9002313.9 101^1^1^31 01101
5253	"DATA",900 2313.91,36 8,10,1,0)
5254	S BPS("X") =""
5255	"DATA",900 2313.91,36 8,20,0)
5256	^9002313.9 102^1^1^31 01101
5257	"DATA",900 2313.91,36 8,20,1,0)
5258	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
5259	"DATA",900 2313.91,36 8,30,0)
5260	^9002313.9 103^1^1^31 01206^
5261	"DATA",900 2313.91,36 8,30,1,0)
5262	; This fie ld current ly not imp lemented
5263	"DATA",900 2313.91,36 9,0)
5264	369^^ADDIT IONAL DCMN TN TYPE ID ^A/N^^^^3^ A/N
5265	"DATA",900 2313.91,36 9,1)
5266	ADDITIONAL DOCUMENTA TION TYPE ID
5267	"DATA",900 2313.91,36 9,5)
5268	2Q^3
5269	"DATA",900 2313.91,36 9,10,0)
5270	^9002313.9 101^1^1^31 01101
5271	"DATA",900 2313.91,36 9,10,1,0)
5272	S BPS("X") =""
5273	"DATA",900 2313.91,36 9,20,0)
5274	^9002313.9 102^1^1^31 01101
5275	"DATA",900 2313.91,36 9,20,1,0)
5276	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
5277	"DATA",900 2313.91,36 9,30,0)
5278	^9002313.9 103^1^1^31 01206^^
5279	"DATA",900 2313.91,36 9,30,1,0)
5280	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 60),U,9)=" "
5281	"DATA",900 2313.91,37 0,0)
5282	370^^LENGT H OF NEED^ N^^^^3^N
5283	"DATA",900 2313.91,37 0,5)
5284	2R^3
5285	"DATA",900 2313.91,37 0,10,0)
5286	^9002313.9 101^1^1^31 01101
5287	"DATA",900 2313.91,37 0,10,1,0)
5288	S BPS("X") =""
5289	"DATA",900 2313.91,37 0,20,0)
5290	^9002313.9 102^1^1^31 01101
5291	"DATA",900 2313.91,37 0,20,1,0)
5292	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),3)
5293	"DATA",900 2313.91,37 0,30,0)
5294	^9002313.9 103^1^1^31 00925^
5295	"DATA",900 2313.91,37 0,30,1,0)
5296	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 60),U,10)= ""
5297	"DATA",900 2313.91,37 1,0)
5298	371^^LENGT H OF NEED QUALIFIER^ N^^^^2^N
5299	"DATA",900 2313.91,37 1,5)
5300	2S^3
5301	"DATA",900 2313.91,37 1,10,0)
5302	^9002313.9 101^1^1^31 01101
5303	"DATA",900 2313.91,37 1,10,1,0)
5304	S BPS("X") =""
5305	"DATA",900 2313.91,37 1,20,0)
5306	^9002313.9 102^1^1^31 01101
5307	"DATA",900 2313.91,37 1,20,1,0)
5308	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
5309	"DATA",900 2313.91,37 1,30,0)
5310	^9002313.9 103^1^1^31 00925^
5311	"DATA",900 2313.91,37 1,30,1,0)
5312	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 70),U,1)=" "
5313	"DATA",900 2313.91,37 2,0)
5314	372^^PRESC RIBER/SUPP LIER DT SI GNED^N^^^^ 8^N
5315	"DATA",900 2313.91,37 2,1)
5316	PRESCRIBER /SUPPLIER DATE SIGNE D
5317	"DATA",900 2313.91,37 2,5)
5318	2T^9
5319	"DATA",900 2313.91,37 2,10,0)
5320	^9002313.9 101^1^1^31 01101
5321	"DATA",900 2313.91,37 2,10,1,0)
5322	S BPS("X") =""
5323	"DATA",900 2313.91,37 2,20,0)
5324	^9002313.9 102^1^1^31 01101
5325	"DATA",900 2313.91,37 2,20,1,0)
5326	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
5327	"DATA",900 2313.91,37 2,30,0)
5328	^9002313.9 103^1^1^31 00925^
5329	"DATA",900 2313.91,37 2,30,1,0)
5330	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 70),U,2)=" "
5331	"DATA",900 2313.91,37 3,0)
5332	373^^REQUE ST STATUS^ A/N^^^^1^A /N
5333	"DATA",900 2313.91,37 3,5)
5334	2U^1
5335	"DATA",900 2313.91,37 3,10,0)
5336	^9002313.9 101^1^1^31 01101
5337	"DATA",900 2313.91,37 3,10,1,0)
5338	S BPS("X") =""
5339	"DATA",900 2313.91,37 3,20,0)
5340	^9002313.9 102^1^1^31 01101
5341	"DATA",900 2313.91,37 3,20,1,0)
5342	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
5343	"DATA",900 2313.91,37 3,30,0)
5344	^9002313.9 103^1^1^31 00925^
5345	"DATA",900 2313.91,37 3,30,1,0)
5346	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 70),U,3)=" "
5347	"DATA",900 2313.91,37 4,0)
5348	374^^REQUE ST PERIOD BEGIN DATE ^N^^^^8^N
5349	"DATA",900 2313.91,37 4,5)
5350	2V^8
5351	"DATA",900 2313.91,37 4,10,0)
5352	^9002313.9 101^1^1^31 01101
5353	"DATA",900 2313.91,37 4,10,1,0)
5354	S BPS("X") =""
5355	"DATA",900 2313.91,37 4,20,0)
5356	^9002313.9 102^1^1^31 01101
5357	"DATA",900 2313.91,37 4,20,1,0)
5358	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
5359	"DATA",900 2313.91,37 4,30,0)
5360	^9002313.9 103^1^1^31 00925^
5361	"DATA",900 2313.91,37 4,30,1,0)
5362	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 70),U,4)=" "
5363	"DATA",900 2313.91,37 5,0)
5364	375^^REQ P ERIOD RECE RT/REVISED DT^N^^^^8 ^N
5365	"DATA",900 2313.91,37 5,1)
5366	REQUEST PE RIOD RECER T/REVISED DATE
5367	"DATA",900 2313.91,37 5,5)
5368	2W^8
5369	"DATA",900 2313.91,37 5,10,0)
5370	^9002313.9 101^1^1^31 01101
5371	"DATA",900 2313.91,37 5,10,1,0)
5372	S BPS("X") =""
5373	"DATA",900 2313.91,37 5,20,0)
5374	^9002313.9 102^1^1^31 01101
5375	"DATA",900 2313.91,37 5,20,1,0)
5376	S BPS("X") =$$DTF1^BP SECFM($G(B PS("X")))
5377	"DATA",900 2313.91,37 5,30,0)
5378	^9002313.9 103^1^1^31 00925^
5379	"DATA",900 2313.91,37 5,30,1,0)
5380	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 70),U,5)=" "
5381	"DATA",900 2313.91,37 6,0)
5382	376^^SUPPO RTING DOCU MENTATION^ A/N^^^^65^ A/N
5383	"DATA",900 2313.91,37 6,5)
5384	2X^65
5385	"DATA",900 2313.91,37 6,10,0)
5386	^9002313.9 101^1^1^31 01101
5387	"DATA",900 2313.91,37 6,10,1,0)
5388	S BPS("X") =""
5389	"DATA",900 2313.91,37 6,20,0)
5390	^9002313.9 102^1^1^31 01101
5391	"DATA",900 2313.91,37 6,20,1,0)
5392	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),6 5)
5393	"DATA",900 2313.91,37 6,30,0)
5394	^9002313.9 103^1^1^31 00925^
5395	"DATA",900 2313.91,37 6,30,1,0)
5396	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 70),U,6)=" "
5397	"DATA",900 2313.91,37 7,0)
5398	377^^QUEST ION NUMBER /LETTER CO UNT^A/N^^^ ^2^N
5399	"DATA",900 2313.91,37 7,5)
5400	2Z^65
5401	"DATA",900 2313.91,37 7,10,0)
5402	^9002313.9 101^1^1^31 01101
5403	"DATA",900 2313.91,37 7,10,1,0)
5404	S BPS("X") =""
5405	"DATA",900 2313.91,37 7,20,0)
5406	^9002313.9 102^1^1^31 01101
5407	"DATA",900 2313.91,37 7,20,1,0)
5408	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
5409	"DATA",900 2313.91,37 8,0)
5410	378^^QUEST ION NUMBER /LETTER^A/ N^^^^3^A/N
5411	"DATA",900 2313.91,37 8,5)
5412	4B^3
5413	"DATA",900 2313.91,37 8,10,0)
5414	^9002313.9 101^1^1^31 01101
5415	"DATA",900 2313.91,37 8,10,1,0)
5416	S BPS("X") =""
5417	"DATA",900 2313.91,37 8,20,0)
5418	^9002313.9 102^1^1^31 01101
5419	"DATA",900 2313.91,37 8,20,1,0)
5420	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
5421	"DATA",900 2313.91,37 8,30,0)
5422	^9002313.9 103^1^1^31 01206^
5423	"DATA",900 2313.91,37 8,30,1,0)
5424	; This fie ld current ly not imp lemented
5425	"DATA",900 2313.91,37 9,0)
5426	379^^QUEST ION PERCEN T RESPONSE ^N^^^^5^N
5427	"DATA",900 2313.91,37 9,5)
5428	4D^5
5429	"DATA",900 2313.91,37 9,10,0)
5430	^9002313.9 101^1^1^31 01101
5431	"DATA",900 2313.91,37 9,10,1,0)
5432	S BPS("X") =""
5433	"DATA",900 2313.91,37 9,20,0)
5434	^9002313.9 102^1^1^31 01101
5435	"DATA",900 2313.91,37 9,20,1,0)
5436	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),5)
5437	"DATA",900 2313.91,37 9,30,0)
5438	^9002313.9 103^1^1^31 01206^
5439	"DATA",900 2313.91,37 9,30,1,0)
5440	; This fie ld current ly not imp lemented
5441	"DATA",900 2313.91,38 0,0)
5442	380^^QUEST ION DATE R ESPONSE^N^ ^^^8^N
5443	"DATA",900 2313.91,38 0,5)
5444	4G^8
5445	"DATA",900 2313.91,38 0,10,0)
5446	^9002313.9 101^1^1^31 01101
5447	"DATA",900 2313.91,38 0,10,1,0)
5448	S BPS("X") =""
5449	"DATA",900 2313.91,38 0,20,0)
5450	^9002313.9 102^1^1^31 01101
5451	"DATA",900 2313.91,38 0,20,1,0)
5452	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
5453	"DATA",900 2313.91,38 0,30,0)
5454	^9002313.9 103^1^1^31 01206^
5455	"DATA",900 2313.91,38 0,30,1,0)
5456	; This fie ld current ly not imp lemented
5457	"DATA",900 2313.91,38 1,0)
5458	381^^QUEST ION DOLLAR AMT RESPO NSE^N^^^^1 1^D
5459	"DATA",900 2313.91,38 1,1)
5460	QUESTION D OLLAR AMOU NT RESPONS E
5461	"DATA",900 2313.91,38 1,5)
5462	4H^9
5463	"DATA",900 2313.91,38 1,10,0)
5464	^9002313.9 101^1^1^31 01101
5465	"DATA",900 2313.91,38 1,10,1,0)
5466	S BPS("X") =""
5467	"DATA",900 2313.91,38 1,20,0)
5468	^9002313.9 102^1^1^31 01101
5469	"DATA",900 2313.91,38 1,20,1,0)
5470	S BPS("X") =$$DFF^BPS ECFM($G(BP S("X")),11 )
5471	"DATA",900 2313.91,38 1,30,0)
5472	^9002313.9 103^1^1^31 01206^
5473	"DATA",900 2313.91,38 1,30,1,0)
5474	; This fie ld current ly not imp lemented
5475	"DATA",900 2313.91,38 2,0)
5476	382^^QUEST ION NUMERI C RESPONSE ^N^^^^11^N
5477	"DATA",900 2313.91,38 2,5)
5478	4J^11
5479	"DATA",900 2313.91,38 2,10,0)
5480	^9002313.9 101^1^1^31 01101
5481	"DATA",900 2313.91,38 2,10,1,0)
5482	S BPS("X") =""
5483	"DATA",900 2313.91,38 2,20,0)
5484	^9002313.9 102^1^1^31 01101
5485	"DATA",900 2313.91,38 2,20,1,0)
5486	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),11 )
5487	"DATA",900 2313.91,38 2,30,0)
5488	^9002313.9 103^1^1^31 01206^
5489	"DATA",900 2313.91,38 2,30,1,0)
5490	; This fie ld current ly not imp lemented
5491	"DATA",900 2313.91,38 3,0)
5492	383^^QUEST ION ALPHAN UMERIC RES PONSE^A/N^ ^^^30^A/N
5493	"DATA",900 2313.91,38 3,5)
5494	4K^30
5495	"DATA",900 2313.91,38 3,10,0)
5496	^9002313.9 101^1^1^31 01101
5497	"DATA",900 2313.91,38 3,10,1,0)
5498	S BPS("X") =""
5499	"DATA",900 2313.91,38 3,20,0)
5500	^9002313.9 102^1^1^31 01101
5501	"DATA",900 2313.91,38 3,20,1,0)
5502	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
5503	"DATA",900 2313.91,38 3,30,0)
5504	^9002313.9 103^1^1^31 01206^
5505	"DATA",900 2313.91,38 3,30,1,0)
5506	; This fie ld current ly not imp lemented
5507	"DATA",900 2313.91,38 4,0)
5508	385^^FACIL ITY NAME^A /N^^^^30^A /N
5509	"DATA",900 2313.91,38 4,5)
5510	3Q^30
5511	"DATA",900 2313.91,38 4,10,0)
5512	^9002313.9 101^1^1^31 01101
5513	"DATA",900 2313.91,38 4,10,1,0)
5514	S BPS("X") =""
5515	"DATA",900 2313.91,38 4,20,0)
5516	^9002313.9 102^1^1^31 01101
5517	"DATA",900 2313.91,38 4,20,1,0)
5518	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
5519	"DATA",900 2313.91,38 4,30,0)
5520	^9002313.9 103^1^1^31 00925^
5521	"DATA",900 2313.91,38 4,30,1,0)
5522	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 80),U,5)=" "
5523	"DATA",900 2313.91,38 5,0)
5524	386^^FACIL ITY STREET ADDRESS^A /N^^^^30^A /N
5525	"DATA",900 2313.91,38 5,5)
5526	3U^30
5527	"DATA",900 2313.91,38 5,10,0)
5528	^9002313.9 101^1^1^31 01101
5529	"DATA",900 2313.91,38 5,10,1,0)
5530	S BPS("X") =""
5531	"DATA",900 2313.91,38 5,20,0)
5532	^9002313.9 102^1^1^31 01101
5533	"DATA",900 2313.91,38 5,20,1,0)
5534	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
5535	"DATA",900 2313.91,38 5,30,0)
5536	^9002313.9 103^1^1^31 00925^
5537	"DATA",900 2313.91,38 5,30,1,0)
5538	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 80),U,6)=" "
5539	"DATA",900 2313.91,38 6,0)
5540	387^^FACIL ITY STATE/ PROV ADDRE SS^A/N^^^^ 2^A/N
5541	"DATA",900 2313.91,38 6,1)
5542	FACILITY S TATE/PROVI NCE ADDRES S
5543	"DATA",900 2313.91,38 6,5)
5544	3V^2
5545	"DATA",900 2313.91,38 6,10,0)
5546	^9002313.9 101^1^1^31 01101
5547	"DATA",900 2313.91,38 6,10,1,0)
5548	S BPS("X") =""
5549	"DATA",900 2313.91,38 6,20,0)
5550	^9002313.9 102^1^1^31 01101
5551	"DATA",900 2313.91,38 6,20,1,0)
5552	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
5553	"DATA",900 2313.91,38 6,30,0)
5554	^9002313.9 103^1^1^31 00925^
5555	"DATA",900 2313.91,38 6,30,1,0)
5556	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 80),U,7)=" "
5557	"DATA",900 2313.91,38 7,0)
5558	388^^FACIL ITY CITY A DDRESS^A/N ^^^^20^A/N
5559	"DATA",900 2313.91,38 7,5)
5560	5J^20
5561	"DATA",900 2313.91,38 7,10,0)
5562	^9002313.9 101^1^1^31 01101
5563	"DATA",900 2313.91,38 7,10,1,0)
5564	S BPS("X") =""
5565	"DATA",900 2313.91,38 7,20,0)
5566	^9002313.9 102^1^1^31 01101
5567	"DATA",900 2313.91,38 7,20,1,0)
5568	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
5569	"DATA",900 2313.91,38 7,30,0)
5570	^9002313.9 103^1^1^31 00925^
5571	"DATA",900 2313.91,38 7,30,1,0)
5572	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 80),U,8)=" "
5573	"DATA",900 2313.91,38 8,0)
5574	389^^FACIL ITY ZIP/PO STAL ZONE^ A/N^^^^15^ A/N
5575	"DATA",900 2313.91,38 8,5)
5576	6D^16
5577	"DATA",900 2313.91,38 8,10,0)
5578	^9002313.9 101^1^1^31 01101
5579	"DATA",900 2313.91,38 8,10,1,0)
5580	S BPS("X") =""
5581	"DATA",900 2313.91,38 8,20,0)
5582	^9002313.9 102^1^1^31 01101
5583	"DATA",900 2313.91,38 8,20,1,0)
5584	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
5585	"DATA",900 2313.91,38 8,30,0)
5586	^9002313.9 103^1^1^31 00925^
5587	"DATA",900 2313.91,38 8,30,1,0)
5588	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 80),U,9)=" "
5589	"DATA",900 2313.91,38 9,0)
5590	390^^NARRA TIVE MESSA GE^A/N^^^^ 200^A/N
5591	"DATA",900 2313.91,38 9,5)
5592	BM^200
5593	"DATA",900 2313.91,38 9,10,0)
5594	^9002313.9 101^1^1^31 01110^
5595	"DATA",900 2313.91,38 9,10,1,0)
5596	S BPS("X") =""
5597	"DATA",900 2313.91,38 9,20,0)
5598	^9002313.9 102^1^1^31 01110^
5599	"DATA",900 2313.91,38 9,20,1,0)
5600	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 00)
5601	"DATA",900 2313.91,38 9,30,0)
5602	^9002313.9 103^1^1^31 01110^^
5603	"DATA",900 2313.91,38 9,30,1,0)
5604	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),3 89),U,2)=" "
5605	"DATA",900 2313.91,39 0,0)
5606	130^^ADDIT IONAL MESS AGE INFO C OUNT^N^^^^ 2^N
5607	"DATA",900 2313.91,39 0,5)
5608	UF^2
5609	"DATA",900 2313.91,39 0,10,0)
5610	^9002313.9 101^1^1^31 01206^
5611	"DATA",900 2313.91,39 0,10,1,0)
5612	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5613	"DATA",900 2313.91,39 1,0)
5614	132^^ADDIT IONAL MSG INFO QUALI FIER^A/N^^ ^^2^A/N
5615	"DATA",900 2313.91,39 1,5)
5616	UH^2
5617	"DATA",900 2313.91,39 1,10,0)
5618	^9002313.9 101^1^1^31 01206^
5619	"DATA",900 2313.91,39 1,10,1,0)
5620	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5621	"DATA",900 2313.91,39 2,0)
5622	131^^ADDIT IONAL MSG INFO CONTI NUITY^N^^^ ^1^A/N
5623	"DATA",900 2313.91,39 2,5)
5624	UG^2
5625	"DATA",900 2313.91,39 2,10,0)
5626	^9002313.9 101^1^1^31 01206^
5627	"DATA",900 2313.91,39 2,10,1,0)
5628	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5629	"DATA",900 2313.91,39 3,0)
5630	987^^URL^A /N^^^^255^ A/N
5631	"DATA",900 2313.91,39 3,5)
5632	MA^255
5633	"DATA",900 2313.91,39 3,10,0)
5634	^9002313.9 101^1^1^31 01206^
5635	"DATA",900 2313.91,39 3,10,1,0)
5636	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5637	"DATA",900 2313.91,39 4,0)
5638	571^^AMOUN T ATTRIB T O PROCESSO R FEE^N^^^ ^8^N
5639	"DATA",900 2313.91,39 4,5)
5640	NZ^8
5641	"DATA",900 2313.91,39 4,10,0)
5642	^9002313.9 101^1^1^31 01206^
5643	"DATA",900 2313.91,39 4,10,1,0)
5644	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5645	"DATA",900 2313.91,39 5,0)
5646	575^^PATIE NT SALES T AX^N^^^^8^ N
5647	"DATA",900 2313.91,39 5,5)
5648	EQ^8
5649	"DATA",900 2313.91,39 5,10,0)
5650	^9002313.9 101^1^1^31 01206^
5651	"DATA",900 2313.91,39 5,10,1,0)
5652	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5653	"DATA",900 2313.91,39 6,0)
5654	574^^PLAN SALES TAX AMOUNT^N^^ ^^8^N
5655	"DATA",900 2313.91,39 6,5)
5656	2Y^8
5657	"DATA",900 2313.91,39 6,10,0)
5658	^9002313.9 101^1^1^31 01206^
5659	"DATA",900 2313.91,39 6,10,1,0)
5660	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5661	"DATA",900 2313.91,39 7,0)
5662	572^^AMOUN T OF COINS URANCE^N^^ ^^8^N
5663	"DATA",900 2313.91,39 7,5)
5664	4U^8
5665	"DATA",900 2313.91,39 7,10,0)
5666	^9002313.9 101^1^1^31 01206^
5667	"DATA",900 2313.91,39 7,10,1,0)
5668	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5669	"DATA",900 2313.91,39 8,0)
5670	573^^BASIS OF CALC - COINSURAN CE^A/N^^^^ 2^A/N
5671	"DATA",900 2313.91,39 8,5)
5672	4V^2
5673	"DATA",900 2313.91,39 8,10,0)
5674	^9002313.9 101^1^1^31 01206^
5675	"DATA",900 2313.91,39 8,10,1,0)
5676	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5677	"DATA",900 2313.91,39 9,0)
5678	577^^ESTIM ATED GENER IC SAVINGS ^N^^^^8^N
5679	"DATA",900 2313.91,39 9,5)
5680	G3^8
5681	"DATA",900 2313.91,39 9,10,0)
5682	^9002313.9 101^1^1^31 01206^
5683	"DATA",900 2313.91,39 9,10,1,0)
5684	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5685	"DATA",900 2313.91,40 0,0)
5686	128^^SPEND ING ACCOUN T AMT REMA INING^N^^^ ^8^N
5687	"DATA",900 2313.91,40 0,5)
5688	UC^8
5689	"DATA",900 2313.91,40 0,10,0)
5690	^9002313.9 101^1^1^31 01206^
5691	"DATA",900 2313.91,40 0,10,1,0)
5692	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5693	"DATA",900 2313.91,40 1,0)
5694	129^^HEALT H PLAN-FUN DED ASSIST AMT^N^^^^ 8^N
5695	"DATA",900 2313.91,40 1,5)
5696	UD^8
5697	"DATA",900 2313.91,40 1,10,0)
5698	^9002313.9 101^1^1^31 01206^
5699	"DATA",900 2313.91,40 1,10,1,0)
5700	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5701	"DATA",900 2313.91,40 2,0)
5702	133^^AMT A TTR TO PRO V NETWORK SLCTN^N^^^ ^8^N
5703	"DATA",900 2313.91,40 2,5)
5704	UJ^8
5705	"DATA",900 2313.91,40 2,10,0)
5706	^9002313.9 101^1^1^31 01206^
5707	"DATA",900 2313.91,40 2,10,1,0)
5708	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5709	"DATA",900 2313.91,40 3,0)
5710	134^^AMT A TTR TO PRO D SEL BRND DRUG^N^^^ ^8^N
5711	"DATA",900 2313.91,40 3,5)
5712	UK^8
5713	"DATA",900 2313.91,40 3,10,0)
5714	^9002313.9 101^1^1^31 01206^
5715	"DATA",900 2313.91,40 3,10,1,0)
5716	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5717	"DATA",900 2313.91,40 4,0)
5718	135^^AMT A TTR NON-PR EF FRMLRY SEL^N^^^^8 ^N
5719	"DATA",900 2313.91,40 4,5)
5720	UM^8
5721	"DATA",900 2313.91,40 4,10,0)
5722	^9002313.9 101^1^1^31 01206^
5723	"DATA",900 2313.91,40 4,10,1,0)
5724	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5725	"DATA",900 2313.91,40 5,0)
5726	136^^AMT A TTR TO N-P REF FRMLRY SEL^N^^^^ 8^N
5727	"DATA",900 2313.91,40 5,5)
5728	UN^8
5729	"DATA",900 2313.91,40 5,10,0)
5730	^9002313.9 101^1^1^31 01206^
5731	"DATA",900 2313.91,40 5,10,1,0)
5732	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5733	"DATA",900 2313.91,40 6,0)
5734	137^^AMOUN T ATTR TO COVERAGE G AP^N^^^^8^ N
5735	"DATA",900 2313.91,40 6,5)
5736	UP^8
5737	"DATA",900 2313.91,40 6,10,0)
5738	^9002313.9 101^1^1^31 01206^
5739	"DATA",900 2313.91,40 6,10,1,0)
5740	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5741	"DATA",900 2313.91,40 7,0)
5742	148^^INGRE D COST CNT RCTD REIMB AMT^N^^^^ 8^N
5743	"DATA",900 2313.91,40 7,5)
5744	U8^8
5745	"DATA",900 2313.91,40 7,10,0)
5746	^9002313.9 101^1^1^31 01206^
5747	"DATA",900 2313.91,40 7,10,1,0)
5748	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5749	"DATA",900 2313.91,40 8,0)
5750	149^^DISP FEE CNTRCT D REIMB AM T^N^^^^8^N
5751	"DATA",900 2313.91,40 8,5)
5752	U9^8
5753	"DATA",900 2313.91,40 8,10,0)
5754	^9002313.9 101^1^1^31 01206^
5755	"DATA",900 2313.91,40 8,10,1,0)
5756	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5757	"DATA",900 2313.91,40 9,0)
5758	570^^DUR A DDITIONAL TEXT^A/N^^ ^^100^A/N
5759	"DATA",900 2313.91,40 9,5)
5760	NS^100
5761	"DATA",900 2313.91,40 9,10,0)
5762	^9002313.9 101^1^1^31 01206^
5763	"DATA",900 2313.91,40 9,10,1,0)
5764	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5765	"DATA",900 2313.91,41 0,0)
5766	355^^OTHER PAYER ID COUNT^N^^^ ^1^N
5767	"DATA",900 2313.91,41 0,5)
5768	NT^1
5769	"DATA",900 2313.91,41 0,10,0)
5770	^9002313.9 101^1^1^31 01206^
5771	"DATA",900 2313.91,41 0,10,1,0)
5772	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5773	"DATA",900 2313.91,41 1,0)
5774	142^^OTHER PAYER PER SON CODE^A /N^^^^3^A/ N
5775	"DATA",900 2313.91,41 1,5)
5776	UV^3
5777	"DATA",900 2313.91,41 1,10,0)
5778	^9002313.9 101^1^1^31 01206^
5779	"DATA",900 2313.91,41 1,10,1,0)
5780	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5781	"DATA",900 2313.91,41 2,0)
5782	127^^OTHER PAYER HEL P DESK PH NUM^A/N^^^ ^18^A/N
5783	"DATA",900 2313.91,41 2,1)
5784	OTHER PAYE R HELP DES K TELEPHON E NUMBER
5785	"DATA",900 2313.91,41 2,5)
5786	UB^18
5787	"DATA",900 2313.91,41 2,10,0)
5788	^9002313.9 101^1^1^31 01206^
5789	"DATA",900 2313.91,41 2,10,1,0)
5790	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5791	"DATA",900 2313.91,41 3,0)
5792	143^^OTHER PAYER PAT IENT REL C ODE^N^^^^1 ^N
5793	"DATA",900 2313.91,41 3,5)
5794	UW^1
5795	"DATA",900 2313.91,41 3,10,0)
5796	^9002313.9 101^1^1^31 01206^
5797	"DATA",900 2313.91,41 3,10,1,0)
5798	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5799	"DATA",900 2313.91,41 4,0)
5800	144^^OTHER PAYER EFF ECTIVE DAT E^N^^^^8^N
5801	"DATA",900 2313.91,41 4,5)
5802	UX^8
5803	"DATA",900 2313.91,41 4,10,0)
5804	^9002313.9 101^1^1^31 01206^
5805	"DATA",900 2313.91,41 4,10,1,0)
5806	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5807	"DATA",900 2313.91,41 5,0)
5808	145^^OTHER PAYER TER MINATION D ATE^N^^^^8 ^N
5809	"DATA",900 2313.91,41 5,5)
5810	UY^8
5811	"DATA",900 2313.91,41 5,10,0)
5812	^9002313.9 101^1^1^31 01206^
5813	"DATA",900 2313.91,41 5,10,1,0)
5814	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5815	"DATA",900 2313.91,41 6,0)
5816	139^^MEDIC ARE PART D COVERAGE CODE^N^^^^ 2^N
5817	"DATA",900 2313.91,41 6,5)
5818	UR^2
5819	"DATA",900 2313.91,41 6,10,0)
5820	^9002313.9 101^1^1^31 01206^
5821	"DATA",900 2313.91,41 6,10,1,0)
5822	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5823	"DATA",900 2313.91,41 7,0)
5824	138^^CMS L ICS LEVEL^ A/N^^^^20^ A/N
5825	"DATA",900 2313.91,41 7,5)
5826	UQ^20
5827	"DATA",900 2313.91,41 7,10,0)
5828	^9002313.9 101^1^1^31 01206^
5829	"DATA",900 2313.91,41 7,10,1,0)
5830	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5831	"DATA",900 2313.91,41 8,0)
5832	240^^CONTR ACT NUMBER ^A/N^^^^8^ A/N
5833	"DATA",900 2313.91,41 8,5)
5834	U1^8
5835	"DATA",900 2313.91,41 8,10,0)
5836	^9002313.9 101^1^1^31 01206^
5837	"DATA",900 2313.91,41 8,10,1,0)
5838	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5839	"DATA",900 2313.91,41 9,0)
5840	926^^FORMU LARY ID^A/ N^^^^10^A/ N
5841	"DATA",900 2313.91,41 9,5)
5842	FF^10
5843	"DATA",900 2313.91,41 9,10,0)
5844	^9002313.9 101^1^1^31 01206^
5845	"DATA",900 2313.91,41 9,10,1,0)
5846	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5847	"DATA",900 2313.91,42 0,0)
5848	757^^BENEF IT ID^A/N^ ^^^15^A/N
5849	"DATA",900 2313.91,42 0,5)
5850	U6^15
5851	"DATA",900 2313.91,42 0,10,0)
5852	^9002313.9 101^1^1^31 01206^
5853	"DATA",900 2313.91,42 0,10,1,0)
5854	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5855	"DATA",900 2313.91,42 1,0)
5856	140^^NEXT MEDICARE P ART D EFF DATE^N^^^^ 8^N
5857	"DATA",900 2313.91,42 1,5)
5858	US^8
5859	"DATA",900 2313.91,42 1,10,0)
5860	^9002313.9 101^1^1^31 01206^
5861	"DATA",900 2313.91,42 1,10,1,0)
5862	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5863	"DATA",900 2313.91,42 2,0)
5864	141^^NEXT MEDICARE P ART D TERM DATE^N^^^ ^8^N
5865	"DATA",900 2313.91,42 2,5)
5866	UT^8
5867	"DATA",900 2313.91,42 2,10,0)
5868	^9002313.9 101^1^1^31 01206^
5869	"DATA",900 2313.91,42 2,10,1,0)
5870	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
5871	"DATA",900 2313.91,42 3,0)
5872	123^^PAY T O STATE/PR OVINCE ADD RESS^A/N^^ ^^2^A/N
5873	"DATA",900 2313.91,42 3,1)
5874	PAY TO STA TE/ PROVIN CE ADDRESS
5875	"DATA",900 2313.91,42 3,5)
5876	TX^2
5877	"DATA",900 2313.91,42 3,10,0)
5878	^9002313.9 101^1^1^31 01101
5879	"DATA",900 2313.91,42 3,10,1,0)
5880	S BPS("X") =""
5881	"DATA",900 2313.91,42 3,20,0)
5882	^9002313.9 102^1^1^31 01101
5883	"DATA",900 2313.91,42 3,20,1,0)
5884	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
5885	"DATA",900 2313.91,42 3,30,0)
5886	^9002313.9 103^1^1^31 00924^
5887	"DATA",900 2313.91,42 3,30,1,0)
5888	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),1 20),U,3)=" "
5889	"DATA",900 2313.91,42 4,0)
5890	579^^ASSOC RX/SERVIC E PROV ID QUAL^A/N^^ ^^2^A/N
5891	"DATA",900 2313.91,42 4,1)
5892	ASSOCIATED PRESCRIPT ION / SERV ICE PROVID ER ID QUAL IFIER
5893	"DATA",900 2313.91,42 4,5)
5894	XX^2
5895	"DATA",900 2313.91,42 4,10,0)
5896	^^1^1^3130 311^
5897	"DATA",900 2313.91,42 4,10,1,0)
5898	S BPS("X") =""
5899	"DATA",900 2313.91,42 4,20,0)
5900	^9002313.9 102^1^1^31 30311^^^^
5901	"DATA",900 2313.91,42 4,20,1,0)
5902	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
5903	"DATA",900 2313.91,42 4,25,0)
5904	^9002313.9 104^1^1^31 30311^^^^
5905	"DATA",900 2313.91,42 4,25,1,0)
5906	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
5907	"DATA",900 2313.91,42 4,30,0)
5908	^9002313.9 103^1^1^31 30311^^^
5909	"DATA",900 2313.91,42 4,30,1,0)
5910	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 70),U,9)=$ G(BPS("X") )
5911	"DATA",900 2313.91,42 5,0)
5912	580^^ASSOC RX/SERVIC E PROVIDER ID^A/N^^^ ^15^A/N
5913	"DATA",900 2313.91,42 5,1)
5914	ASSOCIATED PRESCRIPT ION / SERV ICE PROVID ER ID
5915	"DATA",900 2313.91,42 5,5)
5916	XY^15
5917	"DATA",900 2313.91,42 5,10,0)
5918	^9002313.9 101^1^1^31 30222^^
5919	"DATA",900 2313.91,42 5,10,1,0)
5920	S BPS("X") =""
5921	"DATA",900 2313.91,42 5,20,0)
5922	^9002313.9 102^1^1^31 30222^^
5923	"DATA",900 2313.91,42 5,20,1,0)
5924	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
5925	"DATA",900 2313.91,42 5,25,0)
5926	^9002313.9 104^1^1^31 30222^^
5927	"DATA",900 2313.91,42 5,25,1,0)
5928	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
5929	"DATA",900 2313.91,42 5,30,0)
5930	^^1^1^3130 222^
5931	"DATA",900 2313.91,42 5,30,1,0)
5932	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 70),U,10)= BPS("X")
5933	"DATA",900 2313.91,42 6,0)
5934	581^^ASSOC RX/SERVIC E REF NUM QUAL^A/N^^ ^^2^A/N
5935	"DATA",900 2313.91,42 6,1)
5936	ASSOCIATED PRESCRIPT ION / SERV ICE REFERE NCE NUMBER QUALIFIER
5937	"DATA",900 2313.91,42 6,5)
5938	XZ^2
5939	"DATA",900 2313.91,42 6,10,0)
5940	^^1^1^3130 222^
5941	"DATA",900 2313.91,42 6,10,1,0)
5942	S BPS("X") =""
5943	"DATA",900 2313.91,42 6,20,0)
5944	^^1^1^3130 222^
5945	"DATA",900 2313.91,42 6,20,1,0)
5946	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
5947	"DATA",900 2313.91,42 6,25,0)
5948	^^1^1^3130 222^
5949	"DATA",900 2313.91,42 6,25,1,0)
5950	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
5951	"DATA",900 2313.91,42 6,30,0)
5952	^^1^1^3130 222^
5953	"DATA",900 2313.91,42 6,30,1,0)
5954	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 80),U,1)=B PS("X")
5955	"DATA",900 2313.91,42 7,0)
5956	582^^ASSOC RX/SERVIC E FILL NUM BER^N^^^^2 ^N
5957	"DATA",900 2313.91,42 7,1)
5958	ASSOCIATED PRESCRIPT ION SERVIC E FILL NUM BER
5959	"DATA",900 2313.91,42 7,5)
5960	X0^2
5961	"DATA",900 2313.91,42 7,10,0)
5962	^^1^1^3130 222^
5963	"DATA",900 2313.91,42 7,10,1,0)
5964	S BPS("X") =""
5965	"DATA",900 2313.91,42 7,20,0)
5966	^^1^1^3130 222^
5967	"DATA",900 2313.91,42 7,20,1,0)
5968	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
5969	"DATA",900 2313.91,42 7,25,0)
5970	^^1^1^3130 222^
5971	"DATA",900 2313.91,42 7,25,1,0)
5972	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
5973	"DATA",900 2313.91,42 7,30,0)
5974	^^1^1^3130 222^
5975	"DATA",900 2313.91,42 7,30,1,0)
5976	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 80),U,2)=$ G(BPS("X") )
5977	"DATA",900 2313.91,42 8,0)
5978	583^^SERVI CE PROVIDE R NAME^A/N ^^^^30^A/N
5979	"DATA",900 2313.91,42 8,1)
5980	SERVICE PR OVIDE NAME
5981	"DATA",900 2313.91,42 8,5)
5982	YK^30
5983	"DATA",900 2313.91,42 8,10,0)
5984	^^1^1^3130 228^
5985	"DATA",900 2313.91,42 8,10,1,0)
5986	S BPS("X") =""
5987	"DATA",900 2313.91,42 8,20,0)
5988	^^1^1^3130 222^
5989	"DATA",900 2313.91,42 8,20,1,0)
5990	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
5991	"DATA",900 2313.91,42 8,25,0)
5992	^^1^1^3130 222^
5993	"DATA",900 2313.91,42 8,25,1,0)
5994	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
5995	"DATA",900 2313.91,42 8,30,0)
5996	^^1^1^3130 222^
5997	"DATA",900 2313.91,42 8,30,1,0)
5998	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 80),U,3)=B PS("X")
5999	"DATA",900 2313.91,42 9,0)
6000	584^^SERVI CE PROVIDE R STREET^A /N^^^^30^A /N
6001	"DATA",900 2313.91,42 9,1)
6002	SERVICE PR OVIDER STR EET ADDRES S
6003	"DATA",900 2313.91,42 9,5)
6004	YM^30
6005	"DATA",900 2313.91,42 9,10,0)
6006	^^1^1^3130 222^
6007	"DATA",900 2313.91,42 9,10,1,0)
6008	S BPS("X") =""
6009	"DATA",900 2313.91,42 9,20,0)
6010	^^1^1^3130 222^
6011	"DATA",900 2313.91,42 9,20,1,0)
6012	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
6013	"DATA",900 2313.91,42 9,25,0)
6014	^^1^1^3130 222^
6015	"DATA",900 2313.91,42 9,25,1,0)
6016	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
6017	"DATA",900 2313.91,42 9,30,0)
6018	^^1^1^3130 222^
6019	"DATA",900 2313.91,42 9,30,1,0)
6020	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 80),U,4)=B PS("X")
6021	"DATA",900 2313.91,43 0,0)
6022	585^^SERVI CE PROVIDE R CITY^A/N ^^^^20^A/N
6023	"DATA",900 2313.91,43 0,1)
6024	SERVICE PR OVIDER CIT Y ADDRESS
6025	"DATA",900 2313.91,43 0,5)
6026	YN^20
6027	"DATA",900 2313.91,43 0,10,0)
6028	^9002313.9 101^1^1^31 30228^^
6029	"DATA",900 2313.91,43 0,10,1,0)
6030	S BPS("X") =""
6031	"DATA",900 2313.91,43 0,20,0)
6032	^^1^1^3130 222^
6033	"DATA",900 2313.91,43 0,20,1,0)
6034	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
6035	"DATA",900 2313.91,43 0,25,0)
6036	^^1^1^3130 222^
6037	"DATA",900 2313.91,43 0,25,1,0)
6038	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
6039	"DATA",900 2313.91,43 0,30,0)
6040	^^1^1^3130 222^
6041	"DATA",900 2313.91,43 0,30,1,0)
6042	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 80),U,5)=B PS("X")
6043	"DATA",900 2313.91,43 1,0)
6044	586^^SERVI CE PROVIDE STATE/PRO VINCE^A/N^ ^^^2^A/N
6045	"DATA",900 2313.91,43 1,1)
6046	SERVICE PR OVIDER STA TE/PROVINC E ADDRESS
6047	"DATA",900 2313.91,43 1,5)
6048	YP^2
6049	"DATA",900 2313.91,43 1,10,0)
6050	^^1^1^3130 222^
6051	"DATA",900 2313.91,43 1,10,1,0)
6052	S BPS("X") =""
6053	"DATA",900 2313.91,43 1,20,0)
6054	^^1^1^3130 222^
6055	"DATA",900 2313.91,43 1,20,1,0)
6056	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6057	"DATA",900 2313.91,43 1,25,0)
6058	^^1^1^3130 222^
6059	"DATA",900 2313.91,43 1,25,1,0)
6060	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6061	"DATA",900 2313.91,43 1,30,0)
6062	^^1^1^3130 222^
6063	"DATA",900 2313.91,43 1,30,1,0)
6064	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 80),U,6)=B PS("X")
6065	"DATA",900 2313.91,43 2,0)
6066	587^^SERVI CE PROVIDE R ZIP/POST CODE^A/N^ ^^^15^A/N
6067	"DATA",900 2313.91,43 2,1)
6068	SERVICE PR OVIDER ZIP /POSTAL CO DE
6069	"DATA",900 2313.91,43 2,5)
6070	YQ^15
6071	"DATA",900 2313.91,43 2,10,0)
6072	^9002313.9 101^1^1^31 30222^^
6073	"DATA",900 2313.91,43 2,10,1,0)
6074	S BPS("X") =""
6075	"DATA",900 2313.91,43 2,20,0)
6076	^9002313.9 102^1^1^31 30222^^
6077	"DATA",900 2313.91,43 2,20,1,0)
6078	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
6079	"DATA",900 2313.91,43 2,25,0)
6080	^9002313.9 104^1^1^31 30222^^
6081	"DATA",900 2313.91,43 2,25,1,0)
6082	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
6083	"DATA",900 2313.91,43 2,30,0)
6084	^^1^1^3130 222^
6085	"DATA",900 2313.91,43 2,30,1,0)
6086	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 80),U,7)=B PS("X")
6087	"DATA",900 2313.91,43 3,0)
6088	590^^SELLE R INITIALS ^A/N^^^^3^ A/N
6089	"DATA",900 2313.91,43 3,1)
6090	SELLER INI TIALS
6091	"DATA",900 2313.91,43 3,5)
6092	YT^3
6093	"DATA",900 2313.91,43 3,10,0)
6094	^^1^1^3130 222^
6095	"DATA",900 2313.91,43 3,10,1,0)
6096	S BPS("X") =BPS("Prov ider",MEDN ,"Pharmaci st Initial s")
6097	"DATA",900 2313.91,43 3,20,0)
6098	^9002313.9 102^1^1^31 30222^^^^
6099	"DATA",900 2313.91,43 3,20,1,0)
6100	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
6101	"DATA",900 2313.91,43 3,25,0)
6102	^9002313.9 104^1^1^31 30222^^^^
6103	"DATA",900 2313.91,43 3,25,1,0)
6104	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 )
6105	"DATA",900 2313.91,43 3,30,0)
6106	^9002313.9 103^1^1^31 30222^^^^
6107	"DATA",900 2313.91,43 3,30,1,0)
6108	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 80),U,10)= BPS("X")
6109	"DATA",900 2313.91,43 4,0)
6110	591^^PURCH ASER ID QU ALIFIER^N^ ^^^2^N
6111	"DATA",900 2313.91,43 4,1)
6112	PURCHASER ID QUALIFI ER
6113	"DATA",900 2313.91,43 4,5)
6114	YU^2
6115	"DATA",900 2313.91,43 4,10,0)
6116	^9002313.9 101^1^1^31 30222^^
6117	"DATA",900 2313.91,43 4,10,1,0)
6118	S BPS("X") =""
6119	"DATA",900 2313.91,43 4,20,0)
6120	^9002313.9 102^1^1^31 30222^^
6121	"DATA",900 2313.91,43 4,20,1,0)
6122	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
6123	"DATA",900 2313.91,43 4,25,0)
6124	^9002313.9 104^1^1^31 30222^^
6125	"DATA",900 2313.91,43 4,25,1,0)
6126	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
6127	"DATA",900 2313.91,43 4,30,0)
6128	^^1^1^3130 222^
6129	"DATA",900 2313.91,43 4,30,1,0)
6130	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 90),U,1)=B PS("X")
6131	"DATA",900 2313.91,43 5,0)
6132	592^^PURCH ASER ID^A/ N^^^^20^A/ N
6133	"DATA",900 2313.91,43 5,1)
6134	PURCHASER ID
6135	"DATA",900 2313.91,43 5,5)
6136	YV^20
6137	"DATA",900 2313.91,43 5,10,0)
6138	^9002313.9 101^1^1^31 30222^^
6139	"DATA",900 2313.91,43 5,10,1,0)
6140	S BPS("X") =""
6141	"DATA",900 2313.91,43 5,20,0)
6142	^9002313.9 102^1^1^31 30222^^
6143	"DATA",900 2313.91,43 5,20,1,0)
6144	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
6145	"DATA",900 2313.91,43 5,25,0)
6146	^9002313.9 104^1^1^31 30222^^
6147	"DATA",900 2313.91,43 5,25,1,0)
6148	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
6149	"DATA",900 2313.91,43 5,30,0)
6150	^^1^1^3130 222^
6151	"DATA",900 2313.91,43 5,30,1,0)
6152	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 90),U,2)=B PS("X")
6153	"DATA",900 2313.91,43 6,0)
6154	593^^PURCH ASER ID ST ATE/PROVIN CE^A/N^^^^ 2^A/N
6155	"DATA",900 2313.91,43 6,1)
6156	PURCHASER ID ASSOCIA TED STATE/ PROVINCE A DDRESS
6157	"DATA",900 2313.91,43 6,5)
6158	YW^2
6159	"DATA",900 2313.91,43 6,10,0)
6160	^9002313.9 101^1^1^31 30222^^
6161	"DATA",900 2313.91,43 6,10,1,0)
6162	S BPS("X") =""
6163	"DATA",900 2313.91,43 6,20,0)
6164	^9002313.9 102^1^1^31 30222^^
6165	"DATA",900 2313.91,43 6,20,1,0)
6166	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6167	"DATA",900 2313.91,43 6,25,0)
6168	^9002313.9 104^1^1^31 30222^^
6169	"DATA",900 2313.91,43 6,25,1,0)
6170	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6171	"DATA",900 2313.91,43 6,30,0)
6172	^^1^1^3130 222^
6173	"DATA",900 2313.91,43 6,30,1,0)
6174	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 90),U,3)=B PS("X")
6175	"DATA",900 2313.91,43 7,0)
6176	594^^PURCH ASER DATE OF BIRTH^N ^^^^8^N
6177	"DATA",900 2313.91,43 7,1)
6178	PURCHASER DATE OF BI RTH
6179	"DATA",900 2313.91,43 7,5)
6180	YX^8
6181	"DATA",900 2313.91,43 7,10,0)
6182	^9002313.9 101^1^1^31 30228^^^
6183	"DATA",900 2313.91,43 7,10,1,0)
6184	S BPS("X") =""
6185	"DATA",900 2313.91,43 7,20,0)
6186	^^1^1^3130 228^
6187	"DATA",900 2313.91,43 7,20,1,0)
6188	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
6189	"DATA",900 2313.91,43 7,25,0)
6190	^9002313.9 104^1^1^31 30228^^^
6191	"DATA",900 2313.91,43 7,25,1,0)
6192	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
6193	"DATA",900 2313.91,43 7,30,0)
6194	^9002313.9 103^1^1^31 30228^^
6195	"DATA",900 2313.91,43 7,30,1,0)
6196	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 90),U,4)=B PS("X")
6197	"DATA",900 2313.91,43 8,0)
6198	595^^PURCH ASER GENDE R CODE^N^^ ^^1^N
6199	"DATA",900 2313.91,43 8,1)
6200	PURCHASER GENDER COD E
6201	"DATA",900 2313.91,43 8,5)
6202	YY^1
6203	"DATA",900 2313.91,43 8,10,0)
6204	^^1^1^3130 228^
6205	"DATA",900 2313.91,43 8,10,1,0)
6206	S BPS("X") =""
6207	"DATA",900 2313.91,43 8,20,0)
6208	^^1^1^3130 222^
6209	"DATA",900 2313.91,43 8,20,1,0)
6210	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
6211	"DATA",900 2313.91,43 8,25,0)
6212	^^1^1^3130 222^
6213	"DATA",900 2313.91,43 8,25,1,0)
6214	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
6215	"DATA",900 2313.91,43 8,30,0)
6216	^^1^1^3130 222^
6217	"DATA",900 2313.91,43 8,30,1,0)
6218	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 90),U,5)=B PS("X")
6219	"DATA",900 2313.91,43 9,0)
6220	596^^PURCH ASER FIRST NAME^A/N^ ^^^12^A/N
6221	"DATA",900 2313.91,43 9,1)
6222	PURCHASER FIRST NAME
6223	"DATA",900 2313.91,43 9,5)
6224	YZ^12
6225	"DATA",900 2313.91,43 9,10,0)
6226	^^1^1^3130 222^
6227	"DATA",900 2313.91,43 9,10,1,0)
6228	S BPS("X") =""
6229	"DATA",900 2313.91,43 9,20,0)
6230	^^1^1^3130 222^
6231	"DATA",900 2313.91,43 9,20,1,0)
6232	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 2)
6233	"DATA",900 2313.91,43 9,25,0)
6234	^^1^1^3130 222^
6235	"DATA",900 2313.91,43 9,25,1,0)
6236	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 2)
6237	"DATA",900 2313.91,43 9,30,0)
6238	^^1^1^3130 222^
6239	"DATA",900 2313.91,43 9,30,1,0)
6240	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 90),U,6)=B PS("X")
6241	"DATA",900 2313.91,44 0,0)
6242	597^^PURCH ASER LAST NAME^A/N^^ ^^15^A/N
6243	"DATA",900 2313.91,44 0,1)
6244	PURCHASER LAST NAME
6245	"DATA",900 2313.91,44 0,5)
6246	Y0^15
6247	"DATA",900 2313.91,44 0,10,0)
6248	^9002313.9 101^1^1^31 30403^^
6249	"DATA",900 2313.91,44 0,10,1,0)
6250	S BPS("X") =""
6251	"DATA",900 2313.91,44 0,20,0)
6252	^9002313.9 102^1^1^31 30403^^
6253	"DATA",900 2313.91,44 0,20,1,0)
6254	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
6255	"DATA",900 2313.91,44 0,25,0)
6256	^9002313.9 104^1^1^31 30403^^
6257	"DATA",900 2313.91,44 0,25,1,0)
6258	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
6259	"DATA",900 2313.91,44 0,30,0)
6260	^9002313.9 103^1^1^31 30403^^
6261	"DATA",900 2313.91,44 0,30,1,0)
6262	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 90),U,7)=B PS("X")
6263	"DATA",900 2313.91,44 1,0)
6264	598^^PURCH ASER STREE T ADDRESS^ A/N^^^^30^ A/N
6265	"DATA",900 2313.91,44 1,1)
6266	PURCHASER STREET ADD RESS
6267	"DATA",900 2313.91,44 1,5)
6268	Y1^30
6269	"DATA",900 2313.91,44 1,10,0)
6270	^^1^1^3130 222^
6271	"DATA",900 2313.91,44 1,10,1,0)
6272	S BPS("X") =""
6273	"DATA",900 2313.91,44 1,20,0)
6274	^^1^1^3130 222^
6275	"DATA",900 2313.91,44 1,20,1,0)
6276	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
6277	"DATA",900 2313.91,44 1,25,0)
6278	^^1^1^3130 222^
6279	"DATA",900 2313.91,44 1,25,1,0)
6280	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 0)
6281	"DATA",900 2313.91,44 1,30,0)
6282	^^1^1^3130 222^
6283	"DATA",900 2313.91,44 1,30,1,0)
6284	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 90),U,8)=B PS("X")
6285	"DATA",900 2313.91,44 2,0)
6286	599^^PURCH ASER CITY ADDRESS^A/ N^^^^20^A/ N
6287	"DATA",900 2313.91,44 2,1)
6288	PURCHASER CITY ADDRE SS
6289	"DATA",900 2313.91,44 2,5)
6290	Y2^20
6291	"DATA",900 2313.91,44 2,10,0)
6292	^^1^1^3130 222^
6293	"DATA",900 2313.91,44 2,10,1,0)
6294	S BPS("X") =""
6295	"DATA",900 2313.91,44 2,20,0)
6296	^^1^1^3130 222^
6297	"DATA",900 2313.91,44 2,20,1,0)
6298	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
6299	"DATA",900 2313.91,44 2,25,0)
6300	^^1^1^3130 222^
6301	"DATA",900 2313.91,44 2,25,1,0)
6302	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
6303	"DATA",900 2313.91,44 2,30,0)
6304	^^1^1^3130 222^
6305	"DATA",900 2313.91,44 2,30,1,0)
6306	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),5 90),U,9)=B PS("X")
6307	"DATA",900 2313.91,44 3,0)
6308	675^^PURCH ASER STATE /PROVINCE CODE^A/N^^ ^^2^A/N
6309	"DATA",900 2313.91,44 3,1)
6310	PURCHASER ADDRESS ST ATE/PROVIN CE CODE
6311	"DATA",900 2313.91,44 3,5)
6312	Y3^2
6313	"DATA",900 2313.91,44 3,10,0)
6314	^9002313.9 101^1^1^31 30222^^
6315	"DATA",900 2313.91,44 3,10,1,0)
6316	S BPS("X") =""
6317	"DATA",900 2313.91,44 3,20,0)
6318	^^1^1^3130 222^
6319	"DATA",900 2313.91,44 3,20,1,0)
6320	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6321	"DATA",900 2313.91,44 3,25,0)
6322	^9002313.9 104^1^1^31 30222^^
6323	"DATA",900 2313.91,44 3,25,1,0)
6324	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6325	"DATA",900 2313.91,44 3,30,0)
6326	^^1^1^3130 222^
6327	"DATA",900 2313.91,44 3,30,1,0)
6328	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),6 70),U,5)=B PS("X")
6329	"DATA",900 2313.91,44 4,0)
6330	676^^PURCH ASER ZIP/P OSTAL CODE ^A/N^^^^15 ^A/N
6331	"DATA",900 2313.91,44 4,1)
6332	PURCHASER ZIP/POSTAL CODE
6333	"DATA",900 2313.91,44 4,5)
6334	Y4^15
6335	"DATA",900 2313.91,44 4,10,0)
6336	^9002313.9 101^1^1^31 30222^^
6337	"DATA",900 2313.91,44 4,10,1,0)
6338	S BPS("X") =""
6339	"DATA",900 2313.91,44 4,20,0)
6340	^9002313.9 102^1^1^31 30222^^
6341	"DATA",900 2313.91,44 4,20,1,0)
6342	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
6343	"DATA",900 2313.91,44 4,25,0)
6344	^9002313.9 104^1^1^31 30222^^
6345	"DATA",900 2313.91,44 4,25,1,0)
6346	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
6347	"DATA",900 2313.91,44 4,30,0)
6348	^9002313.9 103^1^1^31 30222^^^
6349	"DATA",900 2313.91,44 4,30,1,0)
6350	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),6 70),U,6)=B PS("X")
6351	"DATA",900 2313.91,44 5,0)
6352	677^^PURCH ASER COUNT RY CODE^A/ N^^^^2^A/N
6353	"DATA",900 2313.91,44 5,1)
6354	PURCHASER COUNTRY CO DE
6355	"DATA",900 2313.91,44 5,5)
6356	Y5^2
6357	"DATA",900 2313.91,44 5,10,0)
6358	^^1^1^3130 222^
6359	"DATA",900 2313.91,44 5,10,1,0)
6360	S BPS("X") =""
6361	"DATA",900 2313.91,44 5,20,0)
6362	^^1^1^3130 222^
6363	"DATA",900 2313.91,44 5,20,1,0)
6364	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6365	"DATA",900 2313.91,44 5,25,0)
6366	^^1^1^3130 222^
6367	"DATA",900 2313.91,44 5,25,1,0)
6368	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6369	"DATA",900 2313.91,44 5,30,0)
6370	^^1^1^3130 222^
6371	"DATA",900 2313.91,44 5,30,1,0)
6372	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),6 70),U,7)=B PS("X")
6373	"DATA",900 2313.91,44 6,0)
6374	678^^TIME OF SERVICE ^N^^^^6^N
6375	"DATA",900 2313.91,44 6,1)
6376	TIME OF SE RVICE
6377	"DATA",900 2313.91,44 6,5)
6378	Y6^6
6379	"DATA",900 2313.91,44 6,10,0)
6380	^^1^1^3130 222^
6381	"DATA",900 2313.91,44 6,10,1,0)
6382	S BPS("X") =BPS("Clai m",MEDN,"T ime of Ser vice")
6383	"DATA",900 2313.91,44 6,20,0)
6384	^9002313.9 102^1^1^31 30222^^
6385	"DATA",900 2313.91,44 6,20,1,0)
6386	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),6)
6387	"DATA",900 2313.91,44 6,25,0)
6388	^9002313.9 104^1^1^31 30222^^
6389	"DATA",900 2313.91,44 6,25,1,0)
6390	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),6)
6391	"DATA",900 2313.91,44 6,30,0)
6392	^9002313.9 103^1^1^31 30222^^
6393	"DATA",900 2313.91,44 6,30,1,0)
6394	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),6 70),U,8)=B PS("X")
6395	"DATA",900 2313.91,44 7,0)
6396	679^^SELLE R ID^A/N^^ ^^70^A/N
6397	"DATA",900 2313.91,44 7,1)
6398	SELLER ID
6399	"DATA",900 2313.91,44 7,5)
6400	Y9^70
6401	"DATA",900 2313.91,44 7,10,0)
6402	^^1^1^3130 222^
6403	"DATA",900 2313.91,44 7,10,1,0)
6404	S BPS("X") =BPS("Prov ider",MEDN ,"Pharmaci st ID")
6405	"DATA",900 2313.91,44 7,20,0)
6406	^9002313.9 102^1^1^31 30222^^
6407	"DATA",900 2313.91,44 7,20,1,0)
6408	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),7 0)
6409	"DATA",900 2313.91,44 7,25,0)
6410	^9002313.9 104^1^1^31 30222^^
6411	"DATA",900 2313.91,44 7,25,1,0)
6412	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),7 0)
6413	"DATA",900 2313.91,44 7,30,0)
6414	^9002313.9 103^1^1^31 30222^^
6415	"DATA",900 2313.91,44 7,30,1,0)
6416	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),6 70),U,9)=B PS("X")
6417	"DATA",900 2313.91,44 8,0)
6418	680^^SELLE R ID QUALI FIER^N^^^^ 2^N
6419	"DATA",900 2313.91,44 8,1)
6420	SELLER ID QUALIFIER
6421	"DATA",900 2313.91,44 8,5)
6422	ZB^2
6423	"DATA",900 2313.91,44 8,10,0)
6424	^^1^1^3130 226^
6425	"DATA",900 2313.91,44 8,10,1,0)
6426	S BPS("X") ="01"
6427	"DATA",900 2313.91,44 8,20,0)
6428	^9002313.9 102^1^1^31 30222^^
6429	"DATA",900 2313.91,44 8,20,1,0)
6430	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
6431	"DATA",900 2313.91,44 8,25,0)
6432	^9002313.9 104^1^1^31 30222^^
6433	"DATA",900 2313.91,44 8,25,1,0)
6434	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
6435	"DATA",900 2313.91,44 8,30,0)
6436	^9002313.9 103^1^1^31 30222^^
6437	"DATA",900 2313.91,44 8,30,1,0)
6438	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),6 70),U,10)= BPS("X")
6439	"DATA",900 2313.91,44 9,0)
6440	681^^SALES TRANSACTI ON ID^A/N^ ^^^80^A/N
6441	"DATA",900 2313.91,44 9,1)
6442	SALES TRAN SACTION ID
6443	"DATA",900 2313.91,44 9,5)
6444	ZF^80
6445	"DATA",900 2313.91,44 9,10,0)
6446	^9002313.9 101^1^1^31 30222^^
6447	"DATA",900 2313.91,44 9,10,1,0)
6448	S BPS("X") =""
6449	"DATA",900 2313.91,44 9,20,0)
6450	^9002313.9 102^1^1^31 30222^^
6451	"DATA",900 2313.91,44 9,20,1,0)
6452	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),8 0)
6453	"DATA",900 2313.91,44 9,25,0)
6454	^9002313.9 104^1^1^31 30222^^
6455	"DATA",900 2313.91,44 9,25,1,0)
6456	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),8 0)
6457	"DATA",900 2313.91,44 9,30,0)
6458	^9002313.9 103^1^1^31 30222^^
6459	"DATA",900 2313.91,44 9,30,1,0)
6460	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201),6 80),U,1)=B PS("X")
6461	"DATA",900 2313.91,45 0,0)
6462	A22^^PATIE NT ID STAT E/PROVINCE ^A/N^^^^2^ A/N
6463	"DATA",900 2313.91,45 0,1)
6464	PATIENT ID ASSOCIATE D STATE/PR OVINCE ADD RESS
6465	"DATA",900 2313.91,45 0,5)
6466	YR^2^1022
6467	"DATA",900 2313.91,45 0,10,0)
6468	^^1^1^3130 222^
6469	"DATA",900 2313.91,45 0,10,1,0)
6470	S BPS("X") =""
6471	"DATA",900 2313.91,45 0,20,0)
6472	^^1^1^3130 222^
6473	"DATA",900 2313.91,45 0,20,1,0)
6474	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6475	"DATA",900 2313.91,45 0,25,0)
6476	^^1^1^3130 222^
6477	"DATA",900 2313.91,45 0,25,1,0)
6478	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6479	"DATA",900 2313.91,45 0,30,0)
6480	^^1^1^3130 227^
6481	"DATA",900 2313.91,45 0,30,1,0)
6482	S $P(^BPSC (BPS(90023 13.02),"A2 0"),U,2)=B PS("X")
6483	"DATA",900 2313.91,45 1,0)
6484	A23^^PURCH ASER RELAT IONSHIP CO DE^A/N^^^^ 2^A/N
6485	"DATA",900 2313.91,45 1,1)
6486	PURCHASER RELATIONSH IP CODE
6487	"DATA",900 2313.91,45 1,5)
6488	YS^2^1023
6489	"DATA",900 2313.91,45 1,10,0)
6490	^9002313.9 101^1^1^31 30222^^
6491	"DATA",900 2313.91,45 1,10,1,0)
6492	S BPS("X") =""
6493	"DATA",900 2313.91,45 1,20,0)
6494	^9002313.9 102^1^1^31 30222^^
6495	"DATA",900 2313.91,45 1,20,1,0)
6496	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6497	"DATA",900 2313.91,45 1,25,0)
6498	^^1^1^3130 222^
6499	"DATA",900 2313.91,45 1,25,1,0)
6500	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6501	"DATA",900 2313.91,45 1,30,0)
6502	^9002313.9 103^1^1^31 30222^^
6503	"DATA",900 2313.91,45 1,30,1,0)
6504	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," A20"),U,3) =BPS("X")
6505	"DATA",900 2313.91,45 2,0)
6506	A24^^PRESC RIBER ID S TATE/PROVI NCE^A/N^^^ ^2^A/N
6507	"DATA",900 2313.91,45 2,1)
6508	PRESCRIBER ID ASSOCI ATED STATE /PROVINCE CODE
6509	"DATA",900 2313.91,45 2,5)
6510	ZK^2^1024
6511	"DATA",900 2313.91,45 2,10,0)
6512	^^1^1^3130 222^
6513	"DATA",900 2313.91,45 2,10,1,0)
6514	S BPS("X") =""
6515	"DATA",900 2313.91,45 2,20,0)
6516	^^1^1^3130 222^
6517	"DATA",900 2313.91,45 2,20,1,0)
6518	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6519	"DATA",900 2313.91,45 2,25,0)
6520	^^1^1^3130 222^
6521	"DATA",900 2313.91,45 2,25,1,0)
6522	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6523	"DATA",900 2313.91,45 2,30,0)
6524	^^1^1^3130 222^
6525	"DATA",900 2313.91,45 2,30,1,0)
6526	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," A20"),U,4) =BPS("X")
6527	"DATA",900 2313.91,45 3,0)
6528	A25^^PRESC RIBER ALTE RNATE ID Q UAL^A/N^^^ ^2^A/N
6529	"DATA",900 2313.91,45 3,1)
6530	PRESCRIBER ALTERNATE ID QUALIF IER
6531	"DATA",900 2313.91,45 3,5)
6532	ZM^2^1025
6533	"DATA",900 2313.91,45 3,10,0)
6534	^^1^1^3130 227^
6535	"DATA",900 2313.91,45 3,10,1,0)
6536	S BPS("X") =""
6537	"DATA",900 2313.91,45 3,20,0)
6538	^^1^1^3130 222^
6539	"DATA",900 2313.91,45 3,20,1,0)
6540	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6541	"DATA",900 2313.91,45 3,25,0)
6542	^^1^1^3130 222^
6543	"DATA",900 2313.91,45 3,25,1,0)
6544	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6545	"DATA",900 2313.91,45 3,30,0)
6546	^9002313.9 103^1^1^31 30227^^
6547	"DATA",900 2313.91,45 3,30,1,0)
6548	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," A20"),U,5) =BPS("X")
6549	"DATA",900 2313.91,45 4,0)
6550	A26^^PRESC RIBER ALTE RNATE ID^A /N^^^^15^A /N
6551	"DATA",900 2313.91,45 4,1)
6552	PRESCRIBER ALTERNATE ID
6553	"DATA",900 2313.91,45 4,5)
6554	ZP^15^1026
6555	"DATA",900 2313.91,45 4,10,0)
6556	^^1^1^3130 222^
6557	"DATA",900 2313.91,45 4,10,1,0)
6558	S BPS("X") =""
6559	"DATA",900 2313.91,45 4,20,0)
6560	^^1^1^3130 222^
6561	"DATA",900 2313.91,45 4,20,1,0)
6562	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
6563	"DATA",900 2313.91,45 4,25,0)
6564	^^1^1^3130 222^
6565	"DATA",900 2313.91,45 4,25,1,0)
6566	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
6567	"DATA",900 2313.91,45 4,30,0)
6568	^^1^1^3130 222^
6569	"DATA",900 2313.91,45 4,30,1,0)
6570	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," A20"),U,6) =BPS("X")
6571	"DATA",900 2313.91,45 5,0)
6572	A27^^PRESC RIBER ALTE RNATE STAT E^A/N^^^^2 ^A/N
6573	"DATA",900 2313.91,45 5,1)
6574	PRESCRIBER ALTERNATE ID ASSOCI ATED STATE /PROVINCE ADDRESS
6575	"DATA",900 2313.91,45 5,5)
6576	ZQ^2^1027
6577	"DATA",900 2313.91,45 5,10,0)
6578	^^1^1^3130 222^
6579	"DATA",900 2313.91,45 5,10,1,0)
6580	S BPS("X") =""
6581	"DATA",900 2313.91,45 5,20,0)
6582	^^1^1^3130 222^
6583	"DATA",900 2313.91,45 5,20,1,0)
6584	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6585	"DATA",900 2313.91,45 5,25,0)
6586	^^1^1^3130 222^
6587	"DATA",900 2313.91,45 5,25,1,0)
6588	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6589	"DATA",900 2313.91,45 5,30,0)
6590	^^1^1^3130 222^
6591	"DATA",900 2313.91,45 5,30,1,0)
6592	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," A20"),U,7) =BPS("X")
6593	"DATA",900 2313.91,45 6,0)
6594	A28^^ADJUD ICATED PAY MENT TYPE^ N^^^^2^N
6595	"DATA",900 2313.91,45 6,1)
6596	ADJUDICATE D PAYMENT TYPE
6597	"DATA",900 2313.91,45 6,5)
6598	ZR^2^1028
6599	"DATA",900 2313.91,45 6,10,0)
6600	^^1^1^3130 222^
6601	"DATA",900 2313.91,45 6,10,1,0)
6602	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
6603	"DATA",900 2313.91,45 7,0)
6604	A29^^REPOR TED PAYMEN T TYPE^N^^ ^^2^N
6605	"DATA",900 2313.91,45 7,1)
6606	REPORTED P AYMENT TYP E
6607	"DATA",900 2313.91,45 7,5)
6608	ZS^2^1029
6609	"DATA",900 2313.91,45 7,10,0)
6610	^^1^1^3130 222^
6611	"DATA",900 2313.91,45 7,10,1,0)
6612	S BPS("X") =""
6613	"DATA",900 2313.91,45 7,20,0)
6614	^^1^1^3130 222^
6615	"DATA",900 2313.91,45 7,20,1,0)
6616	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
6617	"DATA",900 2313.91,45 7,25,0)
6618	^^1^1^3130 222^
6619	"DATA",900 2313.91,45 7,25,1,0)
6620	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
6621	"DATA",900 2313.91,45 7,30,0)
6622	^^1^1^3130 222^
6623	"DATA",900 2313.91,45 7,30,1,0)
6624	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," A20"),U,9) =BPS("X")
6625	"DATA",900 2313.91,45 8,0)
6626	A30^^RELEA SED DATE^N ^^^^8^N
6627	"DATA",900 2313.91,45 8,1)
6628	RELEASED D ATE
6629	"DATA",900 2313.91,45 8,5)
6630	ZT^8^1030
6631	"DATA",900 2313.91,45 8,10,0)
6632	^^1^1^3130 222^
6633	"DATA",900 2313.91,45 8,10,1,0)
6634	S BPS("X") =""
6635	"DATA",900 2313.91,45 8,20,0)
6636	^^1^1^3130 222^
6637	"DATA",900 2313.91,45 8,20,1,0)
6638	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
6639	"DATA",900 2313.91,45 8,25,0)
6640	^^1^1^3130 222^
6641	"DATA",900 2313.91,45 8,25,1,0)
6642	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
6643	"DATA",900 2313.91,45 8,30,0)
6644	^^1^1^3130 222^
6645	"DATA",900 2313.91,45 8,30,1,0)
6646	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," A20"),U,10 )=BPS("X")
6647	"DATA",900 2313.91,45 9,0)
6648	A31^^RELEA SED TIME^N ^^^^6^N
6649	"DATA",900 2313.91,45 9,1)
6650	RELEASED T IME
6651	"DATA",900 2313.91,45 9,5)
6652	ZU^6^1031
6653	"DATA",900 2313.91,45 9,10,0)
6654	^^1^1^3130 228^
6655	"DATA",900 2313.91,45 9,10,1,0)
6656	S BPS("X") =""
6657	"DATA",900 2313.91,45 9,20,0)
6658	^^1^1^3130 222^
6659	"DATA",900 2313.91,45 9,20,1,0)
6660	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),6)
6661	"DATA",900 2313.91,45 9,25,0)
6662	^^1^1^3130 222^
6663	"DATA",900 2313.91,45 9,25,1,0)
6664	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),6)
6665	"DATA",900 2313.91,45 9,30,0)
6666	^^1^1^3130 222^
6667	"DATA",900 2313.91,45 9,30,1,0)
6668	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," A30"),U,1) =BPS("X")
6669	"DATA",900 2313.91,46 0,0)
6670	A32^^COMPO UND PREPAR ATION TIME ^N^^^^4^N
6671	"DATA",900 2313.91,46 0,1)
6672	COMPOUND P REPARATION TIME
6673	"DATA",900 2313.91,46 0,5)
6674	ZW^4^1032
6675	"DATA",900 2313.91,46 0,10,0)
6676	^^1^1^3130 222^
6677	"DATA",900 2313.91,46 0,10,1,0)
6678	S BPS("X") =""
6679	"DATA",900 2313.91,46 0,20,0)
6680	^^1^1^3130 222^
6681	"DATA",900 2313.91,46 0,20,1,0)
6682	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),4)
6683	"DATA",900 2313.91,46 0,25,0)
6684	^^1^1^3130 222^
6685	"DATA",900 2313.91,46 0,25,1,0)
6686	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),4)
6687	"DATA",900 2313.91,46 0,30,0)
6688	^^1^1^3130 222^
6689	"DATA",900 2313.91,46 0,30,1,0)
6690	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," A30"),U,2) =BPS("X")
6691	"DATA",900 2313.91,46 1,0)
6692	A43^^PATIE NT COUNTRY CODE^A/N^ ^^^2^A/N
6693	"DATA",900 2313.91,46 1,1)
6694	PATIENT CO UNTRY CODE
6695	"DATA",900 2313.91,46 1,5)
6696	1K^2^1043
6697	"DATA",900 2313.91,46 1,10,0)
6698	^^1^1^3130 222^
6699	"DATA",900 2313.91,46 1,10,1,0)
6700	S BPS("X") =""
6701	"DATA",900 2313.91,46 1,20,0)
6702	^9002313.9 102^1^1^31 30222^^
6703	"DATA",900 2313.91,46 1,20,1,0)
6704	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6705	"DATA",900 2313.91,46 1,25,0)
6706	^9002313.9 104^1^1^31 30222^^
6707	"DATA",900 2313.91,46 1,25,1,0)
6708	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6709	"DATA",900 2313.91,46 1,30,0)
6710	^^1^1^3130 227^
6711	"DATA",900 2313.91,46 1,30,1,0)
6712	S $P(^BPSC (BPS(90023 13.02),"A4 0"),U,3)=B PS("X")
6713	"DATA",900 2313.91,46 2,0)
6714	A45^^VETER INARY USE INDICATOR^ A/N^^^^1^A /N
6715	"DATA",900 2313.91,46 2,1)
6716	VETERINARY USE INDIC ATOR
6717	"DATA",900 2313.91,46 2,5)
6718	1R^1^1045
6719	"DATA",900 2313.91,46 2,10,0)
6720	^^1^1^3130 222^
6721	"DATA",900 2313.91,46 2,10,1,0)
6722	S BPS("X") =""
6723	"DATA",900 2313.91,46 2,20,0)
6724	^^1^1^3130 222^
6725	"DATA",900 2313.91,46 2,20,1,0)
6726	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
6727	"DATA",900 2313.91,46 2,25,0)
6728	^^1^1^3130 222^
6729	"DATA",900 2313.91,46 2,25,1,0)
6730	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 )
6731	"DATA",900 2313.91,46 2,30,0)
6732	^^1^1^3130 227^
6733	"DATA",900 2313.91,46 2,30,1,0)
6734	S $P(^BPSC (BPS(90023 13.02),"A4 0"),U,5)=B PS("X")
6735	"DATA",900 2313.91,46 3,0)
6736	B04^^NEXT AVAILABLE FILL DATE^ N^^^^8^N
6737	"DATA",900 2313.91,46 3,1)
6738	NEXT AVAIL ABLE FILL DATE
6739	"DATA",900 2313.91,46 3,5)
6740	BT^8^2004
6741	"DATA",900 2313.91,46 3,10,0)
6742	^^1^1^3130 222^
6743	"DATA",900 2313.91,46 3,10,1,0)
6744	; This is a response -only fiel d which do es not use the GET, FORMAT, or SET code
6745	"DATA",900 2313.91,46 4,0)
6746	B08^^PATIE NT STREET ADDRESS LI NE 1^^^^^4 0^A/N
6747	"DATA",900 2313.91,46 4,5)
6748	7A^^2008
6749	"DATA",900 2313.91,46 4,10,0)
6750	^^1^1^3150 112^
6751	"DATA",900 2313.91,46 4,10,1,0)
6752	S BPS("X") =$G(BPS("P atient","S treet Addr ess Line 1 "))
6753	"DATA",900 2313.91,46 4,20,0)
6754	^^1^1^3141 223
6755	"DATA",900 2313.91,46 4,20,1,0)
6756	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
6757	"DATA",900 2313.91,46 4,30,0)
6758	^^1^1^3141 223
6759	"DATA",900 2313.91,46 4,30,1,0)
6760	S $P(^BPSC (BPS(90023 13.02),"B0 0"),U,8)=B PS("X")
6761	"DATA",900 2313.91,46 5,0)
6762	B09^^PATIE NT STREET ADDRESS LI NE 2^^^^^4 0^A/N
6763	"DATA",900 2313.91,46 5,5)
6764	7B^^2009
6765	"DATA",900 2313.91,46 5,10,0)
6766	^^1^1^3150 112^
6767	"DATA",900 2313.91,46 5,10,1,0)
6768	S BPS("X") =$G(BPS("P atient","S treet Addr ess Line 2 "))
6769	"DATA",900 2313.91,46 5,20,0)
6770	^^1^1^3141 223
6771	"DATA",900 2313.91,46 5,20,1,0)
6772	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
6773	"DATA",900 2313.91,46 5,30,0)
6774	^^1^1^3141 223
6775	"DATA",900 2313.91,46 5,30,1,0)
6776	S $P(^BPSC (BPS(90023 13.02),"B0 0"),U,9)=B PS("X")
6777	"DATA",900 2313.91,46 6,0)
6778	B38^^PATIE NT ID ASSO C COUNTRY CODE^^^^^2 ^A/N
6779	"DATA",900 2313.91,46 6,1)
6780	PATIENT ID ASSOCIATE D COUNTRY CODE
6781	"DATA",900 2313.91,46 6,5)
6782	1Y^^2038
6783	"DATA",900 2313.91,46 6,10,0)
6784	^^1^1^3141 223
6785	"DATA",900 2313.91,46 6,10,1,0)
6786	S BPS("X") ="US"
6787	"DATA",900 2313.91,46 6,20,0)
6788	^^1^1^3141 223
6789	"DATA",900 2313.91,46 6,20,1,0)
6790	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6791	"DATA",900 2313.91,46 6,30,0)
6792	^^1^1^3141 223
6793	"DATA",900 2313.91,46 6,30,1,0)
6794	S $P(^BPSC (BPS(90023 13.02),"B3 0"),U,8)=B PS("X")
6795	"DATA",900 2313.91,46 7,0)
6796	B26^^PRESC RIBER PHON E NUMBER E XT^^^^^8^N
6797	"DATA",900 2313.91,46 7,1)
6798	PRESCRIBER TELEPHONE NUMBER EX TENSION
6799	"DATA",900 2313.91,46 7,5)
6800	7T^^2026
6801	"DATA",900 2313.91,46 7,10,0)
6802	^^1^1^3141 223
6803	"DATA",900 2313.91,46 7,10,1,0)
6804	S BPS("X") =""
6805	"DATA",900 2313.91,46 7,20,0)
6806	^^1^1^3141 223
6807	"DATA",900 2313.91,46 7,20,1,0)
6808	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
6809	"DATA",900 2313.91,46 7,30,0)
6810	^^1^1^3141 223
6811	"DATA",900 2313.91,46 7,30,1,0)
6812	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B20"),U,6) =BPS("X")
6813	"DATA",900 2313.91,46 8,0)
6814	B27^^PRESC RIBER STRE ET ADDR LI NE 1^^^^^4 0^A/N
6815	"DATA",900 2313.91,46 8,1)
6816	PRESCRIBER STREET AD DRESS LINE 1
6817	"DATA",900 2313.91,46 8,5)
6818	7U^^2027
6819	"DATA",900 2313.91,46 8,10,0)
6820	^^1^1^3150 112^
6821	"DATA",900 2313.91,46 8,10,1,0)
6822	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Prescrib er Street Address Li ne 1"))
6823	"DATA",900 2313.91,46 8,20,0)
6824	^^1^1^3141 223
6825	"DATA",900 2313.91,46 8,20,1,0)
6826	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
6827	"DATA",900 2313.91,46 8,30,0)
6828	^^1^1^3141 223
6829	"DATA",900 2313.91,46 8,30,1,0)
6830	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B20"),U,7) =BPS("X")
6831	"DATA",900 2313.91,46 9,0)
6832	B28^^PRESC RIBER STRE ET ADDR LI NE 2^^^^^4 0^A/N
6833	"DATA",900 2313.91,46 9,1)
6834	PRESCRIBER STREET AD DRESS LINE 2
6835	"DATA",900 2313.91,46 9,5)
6836	7V^^2028
6837	"DATA",900 2313.91,46 9,10,0)
6838	^^1^1^3150 112^
6839	"DATA",900 2313.91,46 9,10,1,0)
6840	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Prescrib er Street Address Li ne 2"))
6841	"DATA",900 2313.91,46 9,20,0)
6842	^^1^1^3141 223
6843	"DATA",900 2313.91,46 9,20,1,0)
6844	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
6845	"DATA",900 2313.91,46 9,30,0)
6846	^^1^1^3141 223
6847	"DATA",900 2313.91,46 9,30,1,0)
6848	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B20"),U,8) =BPS("X")
6849	"DATA",900 2313.91,47 0,0)
6850	B40^^PRES ALT ID ASS OC COUNTRY CODE^^^^^ 2^A/N
6851	"DATA",900 2313.91,47 0,1)
6852	PRESCRIBER ALTERNATE ID ASSOCI ATED COUNT RY CODE
6853	"DATA",900 2313.91,47 0,5)
6854	3A^^2040
6855	"DATA",900 2313.91,47 0,10,0)
6856	^^1^1^3141 223
6857	"DATA",900 2313.91,47 0,10,1,0)
6858	S BPS("X") =""
6859	"DATA",900 2313.91,47 0,20,0)
6860	^^1^1^3141 223
6861	"DATA",900 2313.91,47 0,20,1,0)
6862	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6863	"DATA",900 2313.91,47 0,30,0)
6864	^^1^1^3141 223
6865	"DATA",900 2313.91,47 0,30,1,0)
6866	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B30"),U,10 )=BPS("X")
6867	"DATA",900 2313.91,47 1,0)
6868	B41^^PRES ID ASSOC C OUNTRY COD E^^^^^2^A/ N
6869	"DATA",900 2313.91,47 1,1)
6870	PRESCRIBER ID ASSOCI ATED COUNT RY CODE
6871	"DATA",900 2313.91,47 1,5)
6872	3B^^2041
6873	"DATA",900 2313.91,47 1,10,0)
6874	^9002313.9 101^1^1^31 50112^
6875	"DATA",900 2313.91,47 1,10,1,0)
6876	S BPS("X") ="US"
6877	"DATA",900 2313.91,47 1,20,0)
6878	^^1^1^3141 223
6879	"DATA",900 2313.91,47 1,20,1,0)
6880	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6881	"DATA",900 2313.91,47 1,30,0)
6882	^^1^1^3141 223
6883	"DATA",900 2313.91,47 1,30,1,0)
6884	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B40"),U,1) =BPS("X")
6885	"DATA",900 2313.91,47 2,0)
6886	B42^^PRESC RIBER COUN TRY CODE^^ ^^^2^A/N
6887	"DATA",900 2313.91,47 2,5)
6888	3C^^2042
6889	"DATA",900 2313.91,47 2,10,0)
6890	^^1^1^3150 112^
6891	"DATA",900 2313.91,47 2,10,1,0)
6892	S BPS("X") =$G(BPS("R X",BPS(900 2313.0201) ,"Prescrib er Country "))
6893	"DATA",900 2313.91,47 2,20,0)
6894	^^1^1^3141 223
6895	"DATA",900 2313.91,47 2,20,1,0)
6896	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
6897	"DATA",900 2313.91,47 2,30,0)
6898	^^1^1^3141 223
6899	"DATA",900 2313.91,47 2,30,1,0)
6900	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B40"),U,2) =BPS("X")
6901	"DATA",900 2313.91,47 3,0)
6902	B15^^EMPLO YER STREET ADDRESS L INE 1^^^^^ 40^A/N
6903	"DATA",900 2313.91,47 3,5)
6904	8D^^2015
6905	"DATA",900 2313.91,47 3,10,0)
6906	^^1^1^3141 223
6907	"DATA",900 2313.91,47 3,10,1,0)
6908	S BPS("X") =""
6909	"DATA",900 2313.91,47 3,20,0)
6910	^^1^1^3141 223
6911	"DATA",900 2313.91,47 3,20,1,0)
6912	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
6913	"DATA",900 2313.91,47 3,30,0)
6914	^^1^1^3141 223
6915	"DATA",900 2313.91,47 3,30,1,0)
6916	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B10"),U,5) =BPS("X")
6917	"DATA",900 2313.91,47 4,0)
6918	B16^^EMPLO YER STREET ADDRESS L INE 2^^^^^ 40^A/N
6919	"DATA",900 2313.91,47 4,5)
6920	7G^^2016
6921	"DATA",900 2313.91,47 4,10,0)
6922	^^1^1^3141 223
6923	"DATA",900 2313.91,47 4,10,1,0)
6924	S BPS("X") =""
6925	"DATA",900 2313.91,47 4,20,0)
6926	^^1^1^3141 223
6927	"DATA",900 2313.91,47 4,20,1,0)
6928	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
6929	"DATA",900 2313.91,47 4,30,0)
6930	^^1^1^3141 223
6931	"DATA",900 2313.91,47 4,30,1,0)
6932	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B10"),U,6) =BPS("X")
6933	"DATA",900 2313.91,47 5,0)
6934	B17^^EMPLO YER CONTAC T FIRST NA ME^^^^^35^ A/N
6935	"DATA",900 2313.91,47 5,5)
6936	7H^^2017
6937	"DATA",900 2313.91,47 5,10,0)
6938	^^1^1^3141 223
6939	"DATA",900 2313.91,47 5,10,1,0)
6940	S BPS("X") =""
6941	"DATA",900 2313.91,47 5,20,0)
6942	^^1^1^3141 223
6943	"DATA",900 2313.91,47 5,20,1,0)
6944	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 5)
6945	"DATA",900 2313.91,47 5,30,0)
6946	^^1^1^3141 223
6947	"DATA",900 2313.91,47 5,30,1,0)
6948	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B10"),U,7) =BPS("X")
6949	"DATA",900 2313.91,47 6,0)
6950	B18^^EMPLO YER CONTAC T LAST NAM E^^^^^35^A /N
6951	"DATA",900 2313.91,47 6,5)
6952	7J^^2018
6953	"DATA",900 2313.91,47 6,10,0)
6954	^^1^1^3141 223
6955	"DATA",900 2313.91,47 6,10,1,0)
6956	S BPS("X") =""
6957	"DATA",900 2313.91,47 6,20,0)
6958	^^1^1^3141 223
6959	"DATA",900 2313.91,47 6,20,1,0)
6960	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),3 5)
6961	"DATA",900 2313.91,47 6,30,0)
6962	^^1^1^3141 223
6963	"DATA",900 2313.91,47 6,30,1,0)
6964	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B10"),U,8) =BPS("X")
6965	"DATA",900 2313.91,47 7,0)
6966	B19^^EMPLO YER PHONE NUMBER EXT ^^^^^8^N
6967	"DATA",900 2313.91,47 7,1)
6968	EMPLOYER T ELEPHONE N UMBER EXTE NSION
6969	"DATA",900 2313.91,47 7,5)
6970	7K^^2019
6971	"DATA",900 2313.91,47 7,10,0)
6972	^^1^1^3141 223
6973	"DATA",900 2313.91,47 7,10,1,0)
6974	S BPS("X") =""
6975	"DATA",900 2313.91,47 7,20,0)
6976	^^1^1^3141 223
6977	"DATA",900 2313.91,47 7,20,1,0)
6978	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),8)
6979	"DATA",900 2313.91,47 7,30,0)
6980	^^1^1^3141 223
6981	"DATA",900 2313.91,47 7,30,1,0)
6982	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B10"),U,9) =BPS("X")
6983	"DATA",900 2313.91,47 8,0)
6984	B24^^PAY T O STREET A DDRESS LIN E 1^^^^^40 ^A/N
6985	"DATA",900 2313.91,47 8,5)
6986	7R^^2024
6987	"DATA",900 2313.91,47 8,10,0)
6988	^^1^1^3141 223
6989	"DATA",900 2313.91,47 8,10,1,0)
6990	S BPS("X") =""
6991	"DATA",900 2313.91,47 8,20,0)
6992	^^1^1^3141 223
6993	"DATA",900 2313.91,47 8,20,1,0)
6994	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
6995	"DATA",900 2313.91,47 8,30,0)
6996	^^1^1^3141 223
6997	"DATA",900 2313.91,47 8,30,1,0)
6998	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B20"),U,4) =BPS("X")
6999	"DATA",900 2313.91,47 9,0)
7000	B25^^PAY T O STREET A DDRESS LIN E 2^^^^^40 ^A/N
7001	"DATA",900 2313.91,47 9,5)
7002	7S^^2025
7003	"DATA",900 2313.91,47 9,10,0)
7004	^^1^1^3141 223
7005	"DATA",900 2313.91,47 9,10,1,0)
7006	S BPS("X") =""
7007	"DATA",900 2313.91,47 9,20,0)
7008	^^1^1^3141 223
7009	"DATA",900 2313.91,47 9,20,1,0)
7010	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
7011	"DATA",900 2313.91,47 9,30,0)
7012	^^1^1^3141 223
7013	"DATA",900 2313.91,47 9,30,1,0)
7014	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B20"),U,5) =BPS("X")
7015	"DATA",900 2313.91,48 0,0)
7016	B35^^EMPLO YER COUNTR Y CODE^^^^ ^2^A/N
7017	"DATA",900 2313.91,48 0,5)
7018	1V^^2035
7019	"DATA",900 2313.91,48 0,10,0)
7020	^^1^1^3141 223
7021	"DATA",900 2313.91,48 0,10,1,0)
7022	S BPS("X") =""
7023	"DATA",900 2313.91,48 0,20,0)
7024	^^1^1^3141 223
7025	"DATA",900 2313.91,48 0,20,1,0)
7026	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
7027	"DATA",900 2313.91,48 0,30,0)
7028	^^1^1^3141 223
7029	"DATA",900 2313.91,48 0,30,1,0)
7030	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B30"),U,5) =BPS("X")
7031	"DATA",900 2313.91,48 1,0)
7032	B39^^PAY T O COUNTRY CODE^^^^^2 ^A/N
7033	"DATA",900 2313.91,48 1,5)
7034	1Z^^2039
7035	"DATA",900 2313.91,48 1,10,0)
7036	^^1^1^3141 223
7037	"DATA",900 2313.91,48 1,10,1,0)
7038	S BPS("X") =""
7039	"DATA",900 2313.91,48 1,20,0)
7040	^^1^1^3141 223
7041	"DATA",900 2313.91,48 1,20,1,0)
7042	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
7043	"DATA",900 2313.91,48 1,30,0)
7044	^^1^1^3141 223
7045	"DATA",900 2313.91,48 1,30,1,0)
7046	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B30"),U,9) =BPS("X")
7047	"DATA",900 2313.91,48 2,0)
7048	B13^^AUTH REP STREET ADDRESS L INE 1^^^^^ 40^A/N
7049	"DATA",900 2313.91,48 2,1)
7050	AUTHORIZED REPRESENT ATIVE STRE ET ADDRESS LINE 1
7051	"DATA",900 2313.91,48 2,5)
7052	7D^^2013
7053	"DATA",900 2313.91,48 2,10,0)
7054	^9002313.9 101^1^1^31 50112^
7055	"DATA",900 2313.91,48 2,10,1,0)
7056	S BPS("X") =""
7057	"DATA",900 2313.91,48 2,20,0)
7058	^9002313.9 102^1^1^31 50112^
7059	"DATA",900 2313.91,48 2,20,1,0)
7060	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
7061	"DATA",900 2313.91,48 2,30,0)
7062	^9002313.9 103^1^1^31 50112^
7063	"DATA",900 2313.91,48 2,30,1,0)
7064	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B10"),U,3) =BPS("X")
7065	"DATA",900 2313.91,48 3,0)
7066	B14^^AUTH REP STREET ADDRESS L INE 2^^^^^ 40^A/N
7067	"DATA",900 2313.91,48 3,1)
7068	AUTHORIZED REPRESENT ATIVE STRE ET ADDRESS LINE 2
7069	"DATA",900 2313.91,48 3,5)
7070	8B^^2014
7071	"DATA",900 2313.91,48 3,10,0)
7072	^^1^1^3141 223
7073	"DATA",900 2313.91,48 3,10,1,0)
7074	S BPS("X") =""
7075	"DATA",900 2313.91,48 3,20,0)
7076	^^1^1^3141 223
7077	"DATA",900 2313.91,48 3,20,1,0)
7078	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
7079	"DATA",900 2313.91,48 3,30,0)
7080	^^1^1^3141 223
7081	"DATA",900 2313.91,48 3,30,1,0)
7082	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B10"),U,4) =BPS("X")
7083	"DATA",900 2313.91,48 4,0)
7084	B34^^AUTH REP COUNTR Y CODE^^^^ ^2^A/N
7085	"DATA",900 2313.91,48 4,1)
7086	AUTHORIZED REPRESENT ATIVE COUN TRY CODE
7087	"DATA",900 2313.91,48 4,5)
7088	1U^^2034
7089	"DATA",900 2313.91,48 4,10,0)
7090	^^1^1^3141 223
7091	"DATA",900 2313.91,48 4,10,1,0)
7092	S BPS("X") =""
7093	"DATA",900 2313.91,48 4,20,0)
7094	^^1^1^3141 223
7095	"DATA",900 2313.91,48 4,20,1,0)
7096	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
7097	"DATA",900 2313.91,48 4,30,0)
7098	^^1^1^3141 223
7099	"DATA",900 2313.91,48 4,30,1,0)
7100	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B30"),U,4) =BPS("X")
7101	"DATA",900 2313.91,48 5,0)
7102	B20^^FACIL ITY STREET ADDRESS L INE 1^^^^^ 40^A/N
7103	"DATA",900 2313.91,48 5,5)
7104	7M^^2020
7105	"DATA",900 2313.91,48 5,10,0)
7106	^^1^1^3141 223
7107	"DATA",900 2313.91,48 5,10,1,0)
7108	S BPS("X") =""
7109	"DATA",900 2313.91,48 5,20,0)
7110	^^1^1^3141 223
7111	"DATA",900 2313.91,48 5,20,1,0)
7112	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
7113	"DATA",900 2313.91,48 5,30,0)
7114	^^1^1^3141 223
7115	"DATA",900 2313.91,48 5,30,1,0)
7116	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B10"),U,10 )=BPS("X")
7117	"DATA",900 2313.91,48 6,0)
7118	B21^^FACIL ITY STREET ADDRESS L INE 2^^^^^ 40^A/N
7119	"DATA",900 2313.91,48 6,5)
7120	7N^^2021
7121	"DATA",900 2313.91,48 6,10,0)
7122	^^1^1^3141 223
7123	"DATA",900 2313.91,48 6,10,1,0)
7124	S BPS("X") =""
7125	"DATA",900 2313.91,48 6,20,0)
7126	^^1^1^3141 223
7127	"DATA",900 2313.91,48 6,20,1,0)
7128	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
7129	"DATA",900 2313.91,48 6,30,0)
7130	^^1^1^3141 223
7131	"DATA",900 2313.91,48 6,30,1,0)
7132	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B20"),U,1) =BPS("X")
7133	"DATA",900 2313.91,48 7,0)
7134	B37^^FACIL ITY COUNTR Y CODE^^^^ ^2^A/N
7135	"DATA",900 2313.91,48 7,5)
7136	1X^^2037
7137	"DATA",900 2313.91,48 7,10,0)
7138	^^1^1^3141 223
7139	"DATA",900 2313.91,48 7,10,1,0)
7140	S BPS("X") =""
7141	"DATA",900 2313.91,48 7,20,0)
7142	^^1^1^3141 223
7143	"DATA",900 2313.91,48 7,20,1,0)
7144	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
7145	"DATA",900 2313.91,48 7,30,0)
7146	^^1^1^3141 223
7147	"DATA",900 2313.91,48 7,30,1,0)
7148	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B30"),U,7) =BPS("X")
7149	"DATA",900 2313.91,48 8,0)
7150	B29^^PURCH ASER STREE T ADDRESS LINE1^^^^^ 40^A/N
7151	"DATA",900 2313.91,48 8,1)
7152	PURCHASER STREET ADD RESS LINE 1
7153	"DATA",900 2313.91,48 8,5)
7154	7W^^2029
7155	"DATA",900 2313.91,48 8,10,0)
7156	^^1^1^3141 223
7157	"DATA",900 2313.91,48 8,10,1,0)
7158	S BPS("X") =""
7159	"DATA",900 2313.91,48 8,20,0)
7160	^^1^1^3141 223
7161	"DATA",900 2313.91,48 8,20,1,0)
7162	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
7163	"DATA",900 2313.91,48 8,30,0)
7164	^^1^1^3141 223
7165	"DATA",900 2313.91,48 8,30,1,0)
7166	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B20"),U,9) =BPS("X")
7167	"DATA",900 2313.91,48 9,0)
7168	B30^^PURCH ASER STREE T ADDRESS LINE2^^^^^ 40^A/N
7169	"DATA",900 2313.91,48 9,1)
7170	PURCHASER STREET ADD RESS LINE 2
7171	"DATA",900 2313.91,48 9,5)
7172	7X^^2030
7173	"DATA",900 2313.91,48 9,10,0)
7174	^^1^1^3141 223
7175	"DATA",900 2313.91,48 9,10,1,0)
7176	S BPS("X") =""
7177	"DATA",900 2313.91,48 9,20,0)
7178	^^1^1^3141 223
7179	"DATA",900 2313.91,48 9,20,1,0)
7180	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
7181	"DATA",900 2313.91,48 9,30,0)
7182	^^1^1^3141 223
7183	"DATA",900 2313.91,48 9,30,1,0)
7184	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B20"),U,10 )=BPS("X")
7185	"DATA",900 2313.91,49 0,0)
7186	B43^^PURCH ASER ID AS SOC COUNTR Y CD^^^^^2 ^A/N
7187	"DATA",900 2313.91,49 0,1)
7188	PURCHASER ID ASSOCIA TED COUNTR Y CODE
7189	"DATA",900 2313.91,49 0,5)
7190	3D^^2043
7191	"DATA",900 2313.91,49 0,10,0)
7192	^^1^1^3141 223
7193	"DATA",900 2313.91,49 0,10,1,0)
7194	S BPS("X") =""
7195	"DATA",900 2313.91,49 0,20,0)
7196	^^1^1^3141 223
7197	"DATA",900 2313.91,49 0,20,1,0)
7198	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
7199	"DATA",900 2313.91,49 0,30,0)
7200	^^1^1^3141 223
7201	"DATA",900 2313.91,49 0,30,1,0)
7202	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B40"),U,3) =BPS("X")
7203	"DATA",900 2313.91,49 1,0)
7204	B31^^SERVI CE PROV ST REET ADD L INE 1^^^^^ 40^A/N
7205	"DATA",900 2313.91,49 1,1)
7206	SERVICE PR OVIDER STR EET ADDRES S LINE 1
7207	"DATA",900 2313.91,49 1,5)
7208	7Y^^2031
7209	"DATA",900 2313.91,49 1,10,0)
7210	^^1^1^3141 223
7211	"DATA",900 2313.91,49 1,10,1,0)
7212	S BPS("X") =""
7213	"DATA",900 2313.91,49 1,20,0)
7214	^^1^1^3141 223
7215	"DATA",900 2313.91,49 1,20,1,0)
7216	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
7217	"DATA",900 2313.91,49 1,30,0)
7218	^^1^1^3141 223
7219	"DATA",900 2313.91,49 1,30,1,0)
7220	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B30"),U,1) =BPS("X")
7221	"DATA",900 2313.91,49 2,0)
7222	B32^^SERVI CE PROV ST REET ADD L INE 2^^^^^ 40^A/N
7223	"DATA",900 2313.91,49 2,1)
7224	SERVICE PR OVIDER STR EET ADDRES S LINE 2
7225	"DATA",900 2313.91,49 2,5)
7226	7Z^^2032
7227	"DATA",900 2313.91,49 2,10,0)
7228	^^1^1^3141 223
7229	"DATA",900 2313.91,49 2,10,1,0)
7230	S BPS("X") =""
7231	"DATA",900 2313.91,49 2,20,0)
7232	^^1^1^3141 223
7233	"DATA",900 2313.91,49 2,20,1,0)
7234	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),4 0)
7235	"DATA",900 2313.91,49 2,30,0)
7236	^^1^1^3141 223
7237	"DATA",900 2313.91,49 2,30,1,0)
7238	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B30"),U,2) =BPS("X")
7239	"DATA",900 2313.91,49 3,0)
7240	A93^^SERVI CE PROVIDE R COUNTRY CODE^^^^^2 ^A/N
7241	"DATA",900 2313.91,49 3,5)
7242	1T^^1093
7243	"DATA",900 2313.91,49 3,10,0)
7244	^^1^1^3141 223
7245	"DATA",900 2313.91,49 3,10,1,0)
7246	S BPS("X") =""
7247	"DATA",900 2313.91,49 3,20,0)
7248	^^1^1^3141 223
7249	"DATA",900 2313.91,49 3,20,1,0)
7250	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
7251	"DATA",900 2313.91,49 3,30,0)
7252	^^1^1^3141 223
7253	"DATA",900 2313.91,49 3,30,1,0)
7254	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," A90"),U,3) =BPS("X")
7255	"DATA",900 2313.91,49 4,0)
7256	B44^^INTER MEDIARY ID COUNT^^^^ ^1^N
7257	"DATA",900 2313.91,49 4,5)
7258	8G^^2044
7259	"DATA",900 2313.91,49 4,10,0)
7260	^^1^1^3141 223
7261	"DATA",900 2313.91,49 4,10,1,0)
7262	S BPS("X") =""
7263	"DATA",900 2313.91,49 4,20,0)
7264	^^1^1^3141 223
7265	"DATA",900 2313.91,49 4,20,1,0)
7266	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
7267	"DATA",900 2313.91,49 4,30,0)
7268	^^1^1^3141 223
7269	"DATA",900 2313.91,49 4,30,1,0)
7270	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B40"),U,4) =BPS("X")
7271	"DATA",900 2313.91,49 5,0)
7272	B45^^INTER MEDIARY ID TYPE CODE ^^^^^2^A/N
7273	"DATA",900 2313.91,49 5,5)
7274	8H^^2045
7275	"DATA",900 2313.91,49 5,10,0)
7276	^^1^1^3141 223
7277	"DATA",900 2313.91,49 5,10,1,0)
7278	S BPS("X") =""
7279	"DATA",900 2313.91,49 5,20,0)
7280	^^1^1^3141 223
7281	"DATA",900 2313.91,49 5,20,1,0)
7282	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
7283	"DATA",900 2313.91,49 6,0)
7284	B46^^INTER MEDIARY ID TYPE ENTI TY^^^^^2^A /N
7285	"DATA",900 2313.91,49 6,5)
7286	8J^^2046
7287	"DATA",900 2313.91,49 6,10,0)
7288	^^1^1^3141 223
7289	"DATA",900 2313.91,49 6,10,1,0)
7290	S BPS("X") =""
7291	"DATA",900 2313.91,49 6,20,0)
7292	^^1^1^3141 223
7293	"DATA",900 2313.91,49 6,20,1,0)
7294	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
7295	"DATA",900 2313.91,49 7,0)
7296	B47^^INTER MEDIARY ID QUALIFIER ^^^^^2^A/N
7297	"DATA",900 2313.91,49 7,5)
7298	8K^^2047
7299	"DATA",900 2313.91,49 7,10,0)
7300	^^1^1^3141 223
7301	"DATA",900 2313.91,49 7,10,1,0)
7302	S BPS("X") =""
7303	"DATA",900 2313.91,49 7,20,0)
7304	^^1^1^3141 223
7305	"DATA",900 2313.91,49 7,20,1,0)
7306	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
7307	"DATA",900 2313.91,49 8,0)
7308	B48^^INTER MEDIARY ID ^^^^^20^A/ N
7309	"DATA",900 2313.91,49 8,5)
7310	8M^^2048
7311	"DATA",900 2313.91,49 8,10,0)
7312	^^1^1^3141 223
7313	"DATA",900 2313.91,49 8,10,1,0)
7314	S BPS("X") =""
7315	"DATA",900 2313.91,49 8,20,0)
7316	^^1^1^3141 223
7317	"DATA",900 2313.91,49 8,20,1,0)
7318	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
7319	"DATA",900 2313.91,49 9,0)
7320	B49^^INTER MEDIARY ID STATE/PRO V ADD^^^^^ 2^A/N
7321	"DATA",900 2313.91,49 9,1)
7322	INTERMEDIA RY ID STAT E/PROVINCE ADDRESS
7323	"DATA",900 2313.91,49 9,5)
7324	8N^^2049
7325	"DATA",900 2313.91,49 9,10,0)
7326	^9002313.9 101^1^1^31 41231^
7327	"DATA",900 2313.91,49 9,10,1,0)
7328	S BPS("X") =""
7329	"DATA",900 2313.91,49 9,20,0)
7330	^9002313.9 102^1^1^31 41231^
7331	"DATA",900 2313.91,49 9,20,1,0)
7332	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
7333	"DATA",900 2313.91,50 0,0)
7334	B55^^INTER MEDIARY ID COUNTRY C ODE^^^^^2^ A/N
7335	"DATA",900 2313.91,50 0,5)
7336	8U^^2055
7337	"DATA",900 2313.91,50 0,10,0)
7338	^^1^1^3141 223
7339	"DATA",900 2313.91,50 0,10,1,0)
7340	S BPS("X") =""
7341	"DATA",900 2313.91,50 0,20,0)
7342	^^1^1^3141 223
7343	"DATA",900 2313.91,50 0,20,1,0)
7344	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 )
7345	"DATA",900 2313.91,50 1,0)
7346	B50^^INTER MEDIARY ID RELATION CODE^^^^^1 ^N
7347	"DATA",900 2313.91,50 1,1)
7348	INTERMEDIA RY ID RELA TIONSHIP C ODE
7349	"DATA",900 2313.91,50 1,5)
7350	8P^^2050
7351	"DATA",900 2313.91,50 1,10,0)
7352	^^1^1^3141 223
7353	"DATA",900 2313.91,50 1,10,1,0)
7354	S BPS("X") =""
7355	"DATA",900 2313.91,50 1,20,0)
7356	^^1^1^3141 223
7357	"DATA",900 2313.91,50 1,20,1,0)
7358	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
7359	"DATA",900 2313.91,50 2,0)
7360	B56^^LAST KNOWN BIN NUMBER^^^^ ^6^N
7361	"DATA",900 2313.91,50 2,5)
7362	3E^^2056
7363	"DATA",900 2313.91,50 2,10,0)
7364	^^1^1^3141 223
7365	"DATA",900 2313.91,50 2,10,1,0)
7366	S BPS("X") =""
7367	"DATA",900 2313.91,50 2,20,0)
7368	^^1^1^3141 223
7369	"DATA",900 2313.91,50 2,20,1,0)
7370	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),1)
7371	"DATA",900 2313.91,50 2,30,0)
7372	^^1^1^3141 223
7373	"DATA",900 2313.91,50 2,30,1,0)
7374	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B50"),U,6) =BPS("X")
7375	"DATA",900 2313.91,50 3,0)
7376	B57^^LAST KNOWN PROC ESSOR CNTR L NUM^^^^^ 10^A/N
7377	"DATA",900 2313.91,50 3,1)
7378	LAST KNOWN PROCESSOR CONTROL N UMBER
7379	"DATA",900 2313.91,50 3,5)
7380	3F^^2057
7381	"DATA",900 2313.91,50 3,10,0)
7382	^^1^1^3141 223
7383	"DATA",900 2313.91,50 3,10,1,0)
7384	S BPS("X") =""
7385	"DATA",900 2313.91,50 3,20,0)
7386	^^1^1^3141 223
7387	"DATA",900 2313.91,50 3,20,1,0)
7388	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 0)
7389	"DATA",900 2313.91,50 3,30,0)
7390	^^1^1^3141 223
7391	"DATA",900 2313.91,50 3,30,1,0)
7392	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B50"),U,7) =BPS("X")
7393	"DATA",900 2313.91,50 4,0)
7394	B58^^LAST KNOWN GROU P ID^^^^^1 5^A/N
7395	"DATA",900 2313.91,50 4,5)
7396	3G^^2058
7397	"DATA",900 2313.91,50 4,10,0)
7398	^^1^1^3141 223
7399	"DATA",900 2313.91,50 4,10,1,0)
7400	S BPS("X") =""
7401	"DATA",900 2313.91,50 4,20,0)
7402	^^1^1^3141 223
7403	"DATA",900 2313.91,50 4,20,1,0)
7404	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),1 5)
7405	"DATA",900 2313.91,50 4,30,0)
7406	^^1^1^3141 223
7407	"DATA",900 2313.91,50 4,30,1,0)
7408	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B50"),U,8) =BPS("X")
7409	"DATA",900 2313.91,50 5,0)
7410	B59^^LAST KNOWN CARD HOLDER ID^ ^^^^20^A/N
7411	"DATA",900 2313.91,50 5,5)
7412	3H^^2059
7413	"DATA",900 2313.91,50 5,10,0)
7414	^^1^1^3141 223
7415	"DATA",900 2313.91,50 5,10,1,0)
7416	S BPS("X") =""
7417	"DATA",900 2313.91,50 5,20,0)
7418	^^1^1^3141 223
7419	"DATA",900 2313.91,50 5,20,1,0)
7420	S BPS("X") =$$ANFF^BP SECFM($G(B PS("X")),2 0)
7421	"DATA",900 2313.91,50 5,30,0)
7422	^^1^1^3141 223
7423	"DATA",900 2313.91,50 5,30,1,0)
7424	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B50"),U,9) =BPS("X")
7425	"DATA",900 2313.91,50 6,0)
7426	B60^^YEAR OF LAST PA ID CLAIM^^ ^^^4^N
7427	"DATA",900 2313.91,50 6,5)
7428	3J^^2060
7429	"DATA",900 2313.91,50 6,10,0)
7430	^9002313.9 101^1^1^31 50112^
7431	"DATA",900 2313.91,50 6,10,1,0)
7432	S BPS("X") =""
7433	"DATA",900 2313.91,50 6,20,0)
7434	^^1^1^3150 112^
7435	"DATA",900 2313.91,50 6,20,1,0)
7436	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),4)
7437	"DATA",900 2313.91,50 6,30,0)
7438	^9002313.9 103^1^1^31 50112^
7439	"DATA",900 2313.91,50 6,30,1,0)
7440	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B50"),U,10 )=BPS("X")
7441	"DATA",900 2313.91,50 7,0)
7442	B61^^MONTH OF LAST P AID CLAIM^ ^^^^2^N
7443	"DATA",900 2313.91,50 7,5)
7444	3K^^2061
7445	"DATA",900 2313.91,50 7,10,0)
7446	^^1^1^3141 223
7447	"DATA",900 2313.91,50 7,10,1,0)
7448	S BPS("X") =""
7449	"DATA",900 2313.91,50 7,20,0)
7450	^^1^1^3141 223
7451	"DATA",900 2313.91,50 7,20,1,0)
7452	S BPS("X") =$$NFF^BPS ECFM($G(BP S("X")),2)
7453	"DATA",900 2313.91,50 7,30,0)
7454	^^1^1^3141 223
7455	"DATA",900 2313.91,50 7,30,1,0)
7456	S $P(^BPSC (BPS(90023 13.02),400 ,BPS(90023 13.0201)," B60"),U,1) =BPS("X")
7457	"DATA",900 2313.91,50 8,0)
7458	B22^^HELP DESK TELEP HONE NUMBE R EXT^^^^^ 8^N
7459	"DATA",900 2313.91,50 8,1)
7460	HELP DESK TELEPHONE NUMBER EXT ENSION
7461	"DATA",900 2313.91,50 8,5)
7462	7P^^2022
7463	"DATA",900 2313.91,50 8,10,0)
7464	^^1^1^3141 223
7465	"DATA",900 2313.91,50 8,10,1,0)
7466	; THIS IS A RESPONSE -ONLY FIEL D WHICH DO ES NOT USE THE GET, FORMAT, OR SET CODE
7467	"DATA",900 2313.91,50 9,0)
7468	B33^^PRO S ERVICE FEE CONT/REIM AMT^^^^^6 .2^D
7469	"DATA",900 2313.91,50 9,1)
7470	PROFESSION AL SERVICE FEE CONTR ACTED/REIM BURSEMENT AMOUNT
7471	"DATA",900 2313.91,50 9,5)
7472	6G^^2033
7473	"DATA",900 2313.91,50 9,10,0)
7474	^^1^1^3141 223
7475	"DATA",900 2313.91,50 9,10,1,0)
7476	; THIS IS A RESPONSE -ONLY FIEL D WHICH DO ES NOT USE THE GET, FORMAT, OR SET CODE
7477	"DATA",900 2313.91,51 0,0)
7478	B23^^OTHER PAYER HEL PDESK PHON E EXT^^^^^ 8^N
7479	"DATA",900 2313.91,51 0,1)
7480	OTHER PAYE R HELP DES K TELEPHON E NUMBER E XTENSION
7481	"DATA",900 2313.91,51 0,5)
7482	7Q^^2023
7483	"DATA",900 2313.91,51 0,10,0)
7484	^^1^1^3141 223
7485	"DATA",900 2313.91,51 0,10,1,0)
7486	; THIS IS A RESPONSE -ONLY FIEL D WHICH DO ES NOT USE THE GET, FORMAT, OR SET CODE
7487	"DATA",900 2313.91,51 1,0)
7488	B52^^RESPO NSE INTERM EDIARY AUT H CNT^^^^^ 1^N
7489	"DATA",900 2313.91,51 1,1)
7490	RESPONSE I NTERMEDIAR Y AUTHORIZ ATION COUN T
7491	"DATA",900 2313.91,51 1,5)
7492	8R^^2052
7493	"DATA",900 2313.91,51 1,10,0)
7494	^^1^1^3141 223
7495	"DATA",900 2313.91,51 1,10,1,0)
7496	; THIS IS A RESPONSE -ONLY FIEL D WHICH DO ES NOT USE THE GET, FORMAT, OR SET CODE
7497	"DATA",900 2313.91,51 2,0)
7498	B53^^RESPO NSE INTERM ED AUTH TY PE ID^^^^^ 2^N
7499	"DATA",900 2313.91,51 2,1)
7500	RESPONSE I NTERMEDIAR Y AUTHORIZ ATION TYPE ID
7501	"DATA",900 2313.91,51 2,5)
7502	8S^^2053
7503	"DATA",900 2313.91,51 2,10,0)
7504	^^1^1^3141 223
7505	"DATA",900 2313.91,51 2,10,1,0)
7506	; THIS IS A RESPONSE -ONLY FIEL D WHICH DO ES NOT USE THE GET, FORMAT, OR SET CODE
7507	"DATA",900 2313.91,51 3,0)
7508	B54^^RESPO NSE INTERM EDIARY AUT H ID^^^^^2 0^A/N
7509	"DATA",900 2313.91,51 3,1)
7510	RESPONSE I NTERMEDIAR Y AUTHORIZ ATION ID
7511	"DATA",900 2313.91,51 3,5)
7512	8T^^2054
7513	"DATA",900 2313.91,51 3,10,0)
7514	^^1^1^3141 223
7515	"DATA",900 2313.91,51 3,10,1,0)
7516	; THIS IS A RESPONSE -ONLY FIEL D WHICH DO ES NOT USE THE GET, FORMAT, OR SET CODE
7517	"DATA",900 2313.91,51 4,0)
7518	B51^^INTER MEDIARY ME SSAGE^^^^^ 200^A/N
7519	"DATA",900 2313.91,51 4,5)
7520	8Q^^2051
7521	"DATA",900 2313.91,51 4,10,0)
7522	^^1^1^3141 223
7523	"DATA",900 2313.91,51 4,10,1,0)
7524	; THIS IS A RESPONSE -ONLY FIEL D WHICH DO ES NOT USE THE GET, FORMAT, OR SET CODE
7525	"DATA",900 2313.93,1, 0)
7526	01^M/I Bin Number
7527	"DATA",900 2313.93,2, 0)
7528	02^M/I Ver sion/Relea se Number
7529	"DATA",900 2313.93,3, 0)
7530	03^M/I Tra nsaction C ode
7531	"DATA",900 2313.93,4, 0)
7532	04^M/I Pro cessor Con trol Numbe r
7533	"DATA",900 2313.93,5, 0)
7534	05^M/I Ser vice Provi der Number
7535	"DATA",900 2313.93,6, 0)
7536	06^M/I Gro up ID
7537	"DATA",900 2313.93,7, 0)
7538	07^M/I Car dholder ID
7539	"DATA",900 2313.93,8, 0)
7540	08^M/I Per son Code
7541	"DATA",900 2313.93,9, 0)
7542	09^M/I Dat e Of Birth
7543	"DATA",900 2313.93,10 ,0)
7544	10^M/I Pat ient Gende r Code
7545	"DATA",900 2313.93,11 ,0)
7546	11^M/I Pat ient Relat ionship Co de
7547	"DATA",900 2313.93,12 ,0)
7548	12^M/I Pla ce of Serv ice
7549	"DATA",900 2313.93,13 ,0)
7550	13^M/I Oth er Coverag e Code
7551	"DATA",900 2313.93,14 ,0)
7552	14^M/I Eli gibility C larificati on Code
7553	"DATA",900 2313.93,15 ,0)
7554	15^M/I Dat e of Servi ce
7555	"DATA",900 2313.93,16 ,0)
7556	16^M/I Pre scription/ Service Re ference Nu mber
7557	"DATA",900 2313.93,17 ,0)
7558	17^M/I Fil l Number
7559	"DATA",900 2313.93,18 ,0)
7560	18^M/I Met ric Quanti ty
7561	"DATA",900 2313.93,19 ,0)
7562	19^M/I Day s Supply
7563	"DATA",900 2313.93,20 ,0)
7564	20^M/I Com pound Code
7565	"DATA",900 2313.93,21 ,0)
7566	21^M/I Pro duct/Servi ce ID
7567	"DATA",900 2313.93,22 ,0)
7568	22^M/I Dis pense As W ritten (DA W)/Product Selection Code
7569	"DATA",900 2313.93,23 ,0)
7570	23^M/I Ing redient Co st Submitt ed
7571	"DATA",900 2313.93,24 ,0)
7572	24^M/I SAL ES TAX
7573	"DATA",900 2313.93,25 ,0)
7574	25^M/I Pre scriber ID
7575	"DATA",900 2313.93,26 ,0)
7576	26^M/I Uni t Of Measu re
7577	"DATA",900 2313.93,27 ,0)
7578	27^Product Identifie r not FDA/ NSDE Liste d
7579	"DATA",900 2313.93,28 ,0)
7580	28^M/I Dat e Prescrip tion Writt en
7581	"DATA",900 2313.93,29 ,0)
7582	29^M/I Num ber Of Ref ills Autho rized
7583	"DATA",900 2313.93,30 ,0)
7584	30^Reversa l request outside pr ocessor re versal win dow
7585	"DATA",900 2313.93,31 ,0)
7586	31^No matc hing paid claim foun d for reve rsal reque st
7587	"DATA",900 2313.93,32 ,0)
7588	32^M/I Lev el Of Serv ice
7589	"DATA",900 2313.93,33 ,0)
7590	33^M/I Pre scription Origin Cod e
7591	"DATA",900 2313.93,34 ,0)
7592	34^M/I Sub mission Cl arificatio n Code
7593	"DATA",900 2313.93,35 ,0)
7594	35^M/I Pri mary Care Provider I D
7595	"DATA",900 2313.93,36 ,0)
7596	36^M/I Cli nic ID
7597	"DATA",900 2313.93,37 ,0)
7598	37^(FUTURE USE)
7599	"DATA",900 2313.93,38 ,0)
7600	38^M/I Bas is Of Cost Determina tion
7601	"DATA",900 2313.93,39 ,0)
7602	39^M/I Dia gnosis Cod e
7603	"DATA",900 2313.93,40 ,0)
7604	40^Pharmac y Not Cont racted Wit h Plan On Date Of Se rvice
7605	"DATA",900 2313.93,41 ,0)
7606	41^Submit Bill To Ot her Proces sor Or Pri mary Payer
7607	"DATA",900 2313.93,42 ,0)
7608	42^Plan's Prescriber database indicates Prescriber ID is ina ctive/expi red
7609	"DATA",900 2313.93,43 ,0)
7610	43^Plan DB indicates the assoc DEA to su bmitted Pr escriber I D is inact ive
7611	"DATA",900 2313.93,44 ,0)
7612	44^Plan's Prescriber database indicates DEA to Pre scriber ID not found
7613	"DATA",900 2313.93,45 ,0)
7614	45^(FUTURE USE)
7615	"DATA",900 2313.93,46 ,0)
7616	46^Assoc D EA to subm itted Pres criber ID doesn't al low drug D EA Schedul e
7617	"DATA",900 2313.93,47 ,0)
7618	47^(FUTURE USE)
7619	"DATA",900 2313.93,48 ,0)
7620	48^(FUTURE USE)
7621	"DATA",900 2313.93,49 ,0)
7622	49^(FUTURE USE)
7623	"DATA",900 2313.93,50 ,0)
7624	50^Non-Mat ched Pharm acy Number
7625	"DATA",900 2313.93,51 ,0)
7626	51^Non-Mat ched Group ID
7627	"DATA",900 2313.93,52 ,0)
7628	52^Non-Mat ched Cardh older ID
7629	"DATA",900 2313.93,53 ,0)
7630	53^Non-Mat ched Perso n Code
7631	"DATA",900 2313.93,54 ,0)
7632	54^Non-Mat ched Produ ct/Service ID Number
7633	"DATA",900 2313.93,55 ,0)
7634	55^Non-Mat ched Produ ct Package Size
7635	"DATA",900 2313.93,56 ,0)
7636	56^Non-Mat ched Presc riber ID
7637	"DATA",900 2313.93,57 ,0)
7638	57^Non-Mat ched PA/MC Number
7639	"DATA",900 2313.93,58 ,0)
7640	58^Non-Mat ched Prima ry Prescri ber
7641	"DATA",900 2313.93,59 ,0)
7642	59^Non-Mat ched Clini c ID
7643	"DATA",900 2313.93,60 ,0)
7644	60^Product /Service N ot Covered For Patie nt Age
7645	"DATA",900 2313.93,61 ,0)
7646	61^Product /Service N ot Covered For Patie nt Gender
7647	"DATA",900 2313.93,62 ,0)
7648	62^Patient /Card Hold er ID Name Mismatch
7649	"DATA",900 2313.93,63 ,0)
7650	63^Product /Service I D Not Cove red For In stitutiona lized Pati ent
7651	"DATA",900 2313.93,64 ,0)
7652	64^Claim S ubmitted D oes Not Ma tch Prior Authorizat ion
7653	"DATA",900 2313.93,65 ,0)
7654	65^Patient Is Not Co vered
7655	"DATA",900 2313.93,66 ,0)
7656	66^Patient Age Excee ds Maximum Age
7657	"DATA",900 2313.93,67 ,0)
7658	67^Filled Before Cov erage Effe ctive
7659	"DATA",900 2313.93,68 ,0)
7660	68^Filled After Cove rage Expir ed
7661	"DATA",900 2313.93,69 ,0)
7662	69^Filled After Cove rage Termi nated
7663	"DATA",900 2313.93,70 ,0)
7664	70^Product /Service N ot Covered - Plan/Be nefit Excl usion
7665	"DATA",900 2313.93,71 ,0)
7666	71^Prescri ber ID Is Not Covere d
7667	"DATA",900 2313.93,72 ,0)
7668	72^Primary Prescribe r Is Not C overed
7669	"DATA",900 2313.93,73 ,0)
7670	73^Refills Are Not C overed
7671	"DATA",900 2313.93,74 ,0)
7672	74^Other C arrier Pay ment Meets Or Exceed s Payable
7673	"DATA",900 2313.93,75 ,0)
7674	75^Prior A uthorizati on Require d
7675	"DATA",900 2313.93,76 ,0)
7676	76^Plan Li mitations Exceeded
7677	"DATA",900 2313.93,77 ,0)
7678	77^Discont inued Prod uct/Servic e ID Numbe r
7679	"DATA",900 2313.93,78 ,0)
7680	78^Cost Ex ceeds Maxi mum
7681	"DATA",900 2313.93,79 ,0)
7682	79^Refill Too Soon
7683	"DATA",900 2313.93,80 ,0)
7684	80^Drug-Di agnosis Mi smatch
7685	"DATA",900 2313.93,81 ,0)
7686	81^Claim T oo Old
7687	"DATA",900 2313.93,82 ,0)
7688	82^Claim I s Post-Dat ed
7689	"DATA",900 2313.93,83 ,0)
7690	83^Duplica te Paid/Ca ptured Cla im
7691	"DATA",900 2313.93,84 ,0)
7692	84^Claim H as Not Bee n Paid/Cap tured
7693	"DATA",900 2313.93,85 ,0)
7694	85^Claim N ot Process ed
7695	"DATA",900 2313.93,86 ,0)
7696	86^Submit Manual Rev ersal
7697	"DATA",900 2313.93,87 ,0)
7698	87^Reversa l Not Proc essed
7699	"DATA",900 2313.93,88 ,0)
7700	88^DUR Rej ect Error
7701	"DATA",900 2313.93,89 ,0)
7702	89^Rejecte d Claim Fe es Paid
7703	"DATA",900 2313.93,90 ,0)
7704	90^Host Hu ng Up
7705	"DATA",900 2313.93,91 ,0)
7706	91^Host Re sponse Err or
7707	"DATA",900 2313.93,92 ,0)
7708	92^System Unavailabl e/Host Una vailable
7709	"DATA",900 2313.93,93 ,0)
7710	93^Planned Unavailab le
7711	"DATA",900 2313.93,94 ,0)
7712	94^Invalid Message
7713	"DATA",900 2313.93,95 ,0)
7714	95^Time Ou t
7715	"DATA",900 2313.93,96 ,0)
7716	96^Schedul ed Downtim e
7717	"DATA",900 2313.93,97 ,0)
7718	97^Payer U navailable
7719	"DATA",900 2313.93,98 ,0)
7720	98^Connect ion To Pay er Is Down
7721	"DATA",900 2313.93,99 ,0)
7722	99^Host Pr ocessing E rror
7723	"DATA",900 2313.93,10 0,0)
7724	CA^M/I Pat ient First Name
7725	"DATA",900 2313.93,10 1,0)
7726	CB^M/I Pat ient Last Name
7727	"DATA",900 2313.93,10 2,0)
7728	CC^M/I Car dholder Fi rst Name
7729	"DATA",900 2313.93,10 3,0)
7730	CD^M/I Car dholder La st Name
7731	"DATA",900 2313.93,10 4,0)
7732	CE^M/I Hom e Plan
7733	"DATA",900 2313.93,10 5,0)
7734	CF^M/I Emp loyer Name
7735	"DATA",900 2313.93,10 6,0)
7736	CG^M/I Emp loyer Stre et Address
7737	"DATA",900 2313.93,10 7,0)
7738	CH^M/I Emp loyer City Address
7739	"DATA",900 2313.93,10 8,0)
7740	CI^M/I Emp loyer Stat e/Province Address
7741	"DATA",900 2313.93,10 9,0)
7742	CJ^M/I Emp loyer Zip Postal Zon e
7743	"DATA",900 2313.93,11 0,0)
7744	CK^M/I Emp loyer Phon e Number
7745	"DATA",900 2313.93,11 1,0)
7746	CL^M/I Emp loyer Cont act Name
7747	"DATA",900 2313.93,11 2,0)
7748	CM^M/I Pat ient Stree t Address
7749	"DATA",900 2313.93,11 3,0)
7750	CN^M/I Pat ient City Address
7751	"DATA",900 2313.93,11 4,0)
7752	CO^M/I Pat ient State /Province Address
7753	"DATA",900 2313.93,11 5,0)
7754	CP^M/I Pat ient Zip/P ostal Zone
7755	"DATA",900 2313.93,11 6,0)
7756	CQ^M/I Pat ient Phone Number
7757	"DATA",900 2313.93,11 7,0)
7758	CR^M/I Car rier ID
7759	"DATA",900 2313.93,11 8,0)
7760	CT^Patient Social Se curity Num ber
7761	"DATA",900 2313.93,11 9,0)
7762	DP^M/I DRU G TYPE OVE RRIDE
7763	"DATA",900 2313.93,12 0,0)
7764	DR^M/I Pre scriber La st Name
7765	"DATA",900 2313.93,12 1,0)
7766	DQ^M/I Usu al And Cus tomary Cha rge
7767	"DATA",900 2313.93,12 2,0)
7768	DS^M/I Pos tage Amoun t Claimed
7769	"DATA",900 2313.93,12 3,0)
7770	DT^M/I Spe cial Packa ging Indic ator
7771	"DATA",900 2313.93,12 4,0)
7772	DU^M/I Gro ss Amount Due
7773	"DATA",900 2313.93,12 5,0)
7774	DV^M/I Oth er Payer A mount Paid
7775	"DATA",900 2313.93,12 6,0)
7776	DW^M/I Bas is Of Days Supply De terminatio n
7777	"DATA",900 2313.93,12 7,0)
7778	DX^M/I Pat ient Paid Amount Sub mitted
7779	"DATA",900 2313.93,12 8,0)
7780	DY^M/I Dat e Of Injur y
7781	"DATA",900 2313.93,12 9,0)
7782	DZ^M/I Cla im/Referen ce ID
7783	"DATA",900 2313.93,13 0,0)
7784	E1^M/I Pro duct/Servi ce ID Qual ifier
7785	"DATA",900 2313.93,13 1,0)
7786	E2^M/I Rou te of Admi nistration
7787	"DATA",900 2313.93,13 2,0)
7788	E3^M/I Inc entive Amo unt Submit ted
7789	"DATA",900 2313.93,13 3,0)
7790	E4^M/I Rea son For Se rvice Code
7791	"DATA",900 2313.93,13 4,0)
7792	E5^M/I Pro fessional Service Co de
7793	"DATA",900 2313.93,13 5,0)
7794	E6^M/I Res ult Of Ser vice Code
7795	"DATA",900 2313.93,13 6,0)
7796	E7^M/I Qua ntity Disp ensed
7797	"DATA",900 2313.93,13 7,0)
7798	E8^M/I Oth er Payer D ate
7799	"DATA",900 2313.93,13 8,0)
7800	M1^Patient Not Cover ed In This Aid Categ ory
7801	"DATA",900 2313.93,13 9,0)
7802	M2^Recipie nt Locked In
7803	"DATA",900 2313.93,14 0,0)
7804	M3^Host PA /MC Error
7805	"DATA",900 2313.93,14 1,0)
7806	M4^Prescri ption/Serv ice Refere nce Number /Time Limi t Exceeded
7807	"DATA",900 2313.93,14 2,0)
7808	M5^Require s Manual C laim
7809	"DATA",900 2313.93,14 3,0)
7810	M6^Host El igibility Error
7811	"DATA",900 2313.93,14 4,0)
7812	M7^Host Dr ug File Er ror
7813	"DATA",900 2313.93,14 5,0)
7814	M8^Host Pr ovider Fil e Error
7815	"DATA",900 2313.93,14 6,0)
7816	MZ^Error O verflow
7817	"DATA",900 2313.93,14 7,0)
7818	1C^M/I Smo ker/Non-Sm oker Code
7819	"DATA",900 2313.93,14 8,0)
7820	1E^M/I Pre scriber Lo cation Cod e
7821	"DATA",900 2313.93,14 9,0)
7822	2C^M/I Pre gnancy Ind icator
7823	"DATA",900 2313.93,15 0,0)
7824	2E^M/I Pri mary Care Provider I D Qualifie r
7825	"DATA",900 2313.93,15 1,0)
7826	3A^M/I Req uest Type
7827	"DATA",900 2313.93,15 2,0)
7828	3B^M/I Req uest Perio d Date-Beg in
7829	"DATA",900 2313.93,15 3,0)
7830	3C^M/I Req uest Perio d Date-End
7831	"DATA",900 2313.93,15 4,0)
7832	3D^M/I Bas is Of Requ est
7833	"DATA",900 2313.93,15 5,0)
7834	3E^M/I Aut horized Re presentati ve First N ame
7835	"DATA",900 2313.93,15 6,0)
7836	3F^M/I Aut horized Re presentati ve Last Na me
7837	"DATA",900 2313.93,15 7,0)
7838	3G^M/I Aut horized Re presentati ve Street Address
7839	"DATA",900 2313.93,15 8,0)
7840	3H^M/I Aut horized Re presentati ve City Ad dress
7841	"DATA",900 2313.93,15 9,0)
7842	3J^M/I Aut horized Re presentati ve State/P rovince Ad dress
7843	"DATA",900 2313.93,16 0,0)
7844	3K^M/I Aut horized Re presentati ve Zip/Pos tal Zone
7845	"DATA",900 2313.93,16 1,0)
7846	3M^M/I Pre scriber Ph one Number
7847	"DATA",900 2313.93,16 2,0)
7848	3N^M/I Pri or Authori zed Number -Assigned
7849	"DATA",900 2313.93,16 3,0)
7850	3P^M/I Aut horization Number
7851	"DATA",900 2313.93,16 4,0)
7852	3R^Prior A uthorizati on Not Req uired
7853	"DATA",900 2313.93,16 5,0)
7854	3S^M/I Pri or Authori zation Sup porting Do cumentatio n
7855	"DATA",900 2313.93,16 6,0)
7856	3T^Active Prior Auth Exists Re submit At Expiration Of Prior Auth
7857	"DATA",900 2313.93,16 7,0)
7858	3W^Prior A uthorizati on In Proc ess
7859	"DATA",900 2313.93,16 8,0)
7860	3X^Authori zation Num ber Not Fo und
7861	"DATA",900 2313.93,16 9,0)
7862	3Y^Prior A uthorizati on Denied
7863	"DATA",900 2313.93,17 0,0)
7864	4C^M/I Coo rdination Of Benefit s/Other Pa yments Cou nt
7865	"DATA",900 2313.93,17 1,0)
7866	4E^M/I Pri mary Care Provider L ast Name
7867	"DATA",900 2313.93,17 2,0)
7868	5C^M/I Oth er Payer C overage Ty pe
7869	"DATA",900 2313.93,17 3,0)
7870	5E^M/I Oth er Payer R eject Coun t
7871	"DATA",900 2313.93,17 4,0)
7872	6C^M/I Oth er Payer I D Qualifie r
7873	"DATA",900 2313.93,17 5,0)
7874	6E^M/I Oth er Payer R eject Code
7875	"DATA",900 2313.93,17 6,0)
7876	7C^M/I Oth er Payer I D
7877	"DATA",900 2313.93,17 7,0)
7878	7E^M/I DUR /PPS Code Counter
7879	"DATA",900 2313.93,17 8,0)
7880	8C^M/I Fac ility ID
7881	"DATA",900 2313.93,17 9,0)
7882	8E^M/I DUR /PPS Level Of Effort
7883	"DATA",900 2313.93,18 0,0)
7884	AA^Patient Spenddown Not Met
7885	"DATA",900 2313.93,18 1,0)
7886	AB^Date Wr itten Is A fter Date Filled
7887	"DATA",900 2313.93,18 2,0)
7888	AC^Product Not Cover ed Non-Par ticipating Manufactu rer
7889	"DATA",900 2313.93,18 3,0)
7890	AD^Billing Provider Not Eligib le To Bill This Clai m Type
7891	"DATA",900 2313.93,18 4,0)
7892	AE^QMB (Qu alified Me dicare Ben eficiary)- Bill Medic are
7893	"DATA",900 2313.93,18 5,0)
7894	AF^Patient Enrolled Under Mana ged Care
7895	"DATA",900 2313.93,18 6,0)
7896	AG^Days Su pply Limit ation For Product/Se rvice
7897	"DATA",900 2313.93,18 7,0)
7898	AH^Unit Do se Packagi ng Only Pa yable For Nursing Ho me Recipie nts
7899	"DATA",900 2313.93,18 8,0)
7900	AJ^Generic Drug Requ ired
7901	"DATA",900 2313.93,18 9,0)
7902	AK^M/I Sof tware Vend or/Certifi cation ID
7903	"DATA",900 2313.93,19 0,0)
7904	AM^M/I Seg ment Ident ification
7905	"DATA",900 2313.93,19 1,0)
7906	A9^M/I Tra nsaction C ount
7907	"DATA",900 2313.93,19 2,0)
7908	BE^M/I Pro fessional Service Fe e Submitte d
7909	"DATA",900 2313.93,19 3,0)
7910	B2^M/I Ser vice Provi der ID Qua lifier
7911	"DATA",900 2313.93,19 4,0)
7912	CW^M/I Alt ernate ID
7913	"DATA",900 2313.93,19 5,0)
7914	CX^M/I Pat ient ID Qu alifier
7915	"DATA",900 2313.93,19 6,0)
7916	CY^M/I Pat ient ID
7917	"DATA",900 2313.93,19 7,0)
7918	CZ^M/I Emp loyer ID
7919	"DATA",900 2313.93,19 8,0)
7920	DC^M/I Dis pensing Fe e Submitte d
7921	"DATA",900 2313.93,19 9,0)
7922	DN^M/I Bas is Of Cost Determina tion
7923	"DATA",900 2313.93,20 0,0)
7924	EA^M/I Ori ginally Pr escribed P roduct/Ser vice Code
7925	"DATA",900 2313.93,20 1,0)
7926	EB^M/I Ori ginally Pr escribed Q uantity
7927	"DATA",900 2313.93,20 2,0)
7928	EC^M/I Com pound Ingr edient Com ponent Cou nt
7929	"DATA",900 2313.93,20 3,0)
7930	ED^M/I Com pound Ingr edient Qua ntity
7931	"DATA",900 2313.93,20 4,0)
7932	EE^M/I Com pound Ingr edient Dru g Cost
7933	"DATA",900 2313.93,20 5,0)
7934	EF^M/I Com pound Dosa ge Form De scription Code
7935	"DATA",900 2313.93,20 6,0)
7936	EG^M/I Com pound Disp ensing Uni t Form Ind icator
7937	"DATA",900 2313.93,20 7,0)
7938	EH^M/I Com pound Rout e of Admin istration
7939	"DATA",900 2313.93,20 8,0)
7940	EJ^M/I Ori ginally Pr escribed P roduct/Ser vice ID Qu alifier
7941	"DATA",900 2313.93,20 9,0)
7942	EK^M/I Sch eduled Pre scription ID Number
7943	"DATA",900 2313.93,21 0,0)
7944	EM^M/I Pre scription/ Service Re ference Nu mber Quali fier
7945	"DATA",900 2313.93,21 1,0)
7946	EN^M/I Ass ociated Pr escription /Service R eference N umber
7947	"DATA",900 2313.93,21 2,0)
7948	Ep^M/I Ass ociated Pr escription /Service D ate
7949	"DATA",900 2313.93,21 3,0)
7950	ER^M/I Pro cedure Mod ifier Code
7951	"DATA",900 2313.93,21 4,0)
7952	ET^M/I Qua ntity Pres cribed
7953	"DATA",900 2313.93,21 5,0)
7954	EU^M/I Pri or Authori zation Typ e Code
7955	"DATA",900 2313.93,21 6,0)
7956	EV^M/I Pri or Authori zation ID Submitted
7957	"DATA",900 2313.93,21 7,0)
7958	EW^M/I Int ermediary Authorizat ion Type I D
7959	"DATA",900 2313.93,21 8,0)
7960	EX^M/I Int ermediary Authorizat ion ID
7961	"DATA",900 2313.93,21 9,0)
7962	EY^M/I Pro vider ID Q ualifier
7963	"DATA",900 2313.93,22 0,0)
7964	EZ^M/I Pre scriber ID Qualifier
7965	"DATA",900 2313.93,22 1,0)
7966	E9^M/I Pro vider ID
7967	"DATA",900 2313.93,22 2,0)
7968	FO^M/I Pla n ID
7969	"DATA",900 2313.93,22 3,0)
7970	GE^M/I Per centage Sa les Tax Am ount Submi tted
7971	"DATA",900 2313.93,22 4,0)
7972	HA^M/I Fla t Sales Ta x Amount S ubmitted
7973	"DATA",900 2313.93,22 5,0)
7974	HB^M/I Oth er Payer A mount Paid Count
7975	"DATA",900 2313.93,22 6,0)
7976	HC^M/I Oth er Payer A mount Paid Qualifier
7977	"DATA",900 2313.93,22 7,0)
7978	HD^M/I Dis pensing St atus
7979	"DATA",900 2313.93,22 8,0)
7980	HE^M/I Per centage Sa les Tax Ra te Submitt ed
7981	"DATA",900 2313.93,22 9,0)
7982	HF^M/I Qua ntity Inte nded To Be Dispensed
7983	"DATA",900 2313.93,23 0,0)
7984	HG^M/I Day s Supply I ntended To Be Dispen sed
7985	"DATA",900 2313.93,23 1,0)
7986	H1^M/I Mea surement T ime
7987	"DATA",900 2313.93,23 2,0)
7988	H2^M/I Mea surement D imension
7989	"DATA",900 2313.93,23 3,0)
7990	H3^M/I Mea surement U nit
7991	"DATA",900 2313.93,23 4,0)
7992	H4^M/I Mea surement V alue
7993	"DATA",900 2313.93,23 5,0)
7994	H5^M/I Pri mary Care Provider L ocation Co de
7995	"DATA",900 2313.93,23 6,0)
7996	H6^M/I DUR Co-Agent ID
7997	"DATA",900 2313.93,23 7,0)
7998	H7^M/I Oth er Amount Claimed Su bmitted Co unt
7999	"DATA",900 2313.93,23 8,0)
8000	H8^M/I Oth er Amount Claimed Su bmitted Qu alifier
8001	"DATA",900 2313.93,23 9,0)
8002	H9^M/I Oth er Amount Claimed Su bmitted
8003	"DATA",900 2313.93,24 0,0)
8004	JE^M/I Per centage Sa les Tax Ba sis Submit ted
8005	"DATA",900 2313.93,24 1,0)
8006	J9^M/I DUR Co-Agent ID Qualifi er
8007	"DATA",900 2313.93,24 2,0)
8008	KE^M/I Cou pon Type
8009	"DATA",900 2313.93,24 3,0)
8010	ME^M/I Cou pon Number
8011	"DATA",900 2313.93,24 4,0)
8012	NE^M/I Cou pon Value Amount
8013	"DATA",900 2313.93,24 5,0)
8014	NN^Transac tion Rejec ted At Swi tch Or Int ermediary
8015	"DATA",900 2313.93,24 6,0)
8016	PA^PA Exha usted/Not Renewable
8017	"DATA",900 2313.93,24 7,0)
8018	PB^Invalid Transacti on Count F or This Tr ansaction Code
8019	"DATA",900 2313.93,24 8,0)
8020	PC^M/I Req uest Claim Segment
8021	"DATA",900 2313.93,24 9,0)
8022	PD^M/I Req uest Clini cal Segmen t
8023	"DATA",900 2313.93,25 0,0)
8024	PE^M/I Req uest Coord ination Of Benefits/ Other Paym ents Segme nt
8025	"DATA",900 2313.93,25 1,0)
8026	PF^M/I Req uest Compo und Segmen t
8027	"DATA",900 2313.93,25 2,0)
8028	PG^M/I Req uest Coupo n Segment
8029	"DATA",900 2313.93,25 3,0)
8030	PH^M/I Req uest DUR/P PS Segment
8031	"DATA",900 2313.93,25 4,0)
8032	PJ^M/I Req uest Insur ance Segme nt
8033	"DATA",900 2313.93,25 5,0)
8034	PK^M/I Req uest Patie nt Segment
8035	"DATA",900 2313.93,25 6,0)
8036	PM^M/I Req uest Pharm acy Provid er Segment
8037	"DATA",900 2313.93,25 7,0)
8038	PN^M/I Req uest Presc riber Segm ent
8039	"DATA",900 2313.93,25 8,0)
8040	PP^M/I Req uest Prici ng Segment
8041	"DATA",900 2313.93,25 9,0)
8042	PR^M/I Req uest Prior Authoriza tion Segme nt
8043	"DATA",900 2313.93,26 0,0)
8044	PS^M/I Tra nsaction H eader Segm ent
8045	"DATA",900 2313.93,26 1,0)
8046	PT^M/I Req uest Worke r's Compen sation Seg ment
8047	"DATA",900 2313.93,26 2,0)
8048	PV^Non-Mat ched Assoc iated Pres cription/S ervice Dat e
8049	"DATA",900 2313.93,26 3,0)
8050	PW^Employe r ID Not C overed
8051	"DATA",900 2313.93,26 4,0)
8052	PX^Other P ayer ID No t Covered
8053	"DATA",900 2313.93,26 5,0)
8054	PY^Non-Mat ched Unit Form/Route of Admini stration
8055	"DATA",900 2313.93,26 6,0)
8056	PZ^Non-Mat ched Unit Of Measure To Produc t/Service ID
8057	"DATA",900 2313.93,26 7,0)
8058	P1^Associa ted Prescr iption/Ser vice Refer ence Numbe r Not Foun d
8059	"DATA",900 2313.93,26 8,0)
8060	P2^Clinica l Informat ion Counte r Out Of S equence
8061	"DATA",900 2313.93,26 9,0)
8062	P3^Compoun d Ingredie nt Compone nt Count D oesn't Mat ch # Of Re petitions
8063	"DATA",900 2313.93,27 0,0)
8064	P4^COB/Oth er Payment s Count Do es Not Mat ch Number Of Repetit ions
8065	"DATA",900 2313.93,27 1,0)
8066	P5^Coupon Expired
8067	"DATA",900 2313.93,27 2,0)
8068	P6^Date Of Service P rior To Da te Of Birt h
8069	"DATA",900 2313.93,27 3,0)
8070	P7^Diagnos is Code Co unt Does N ot Match N umber Of R epetitions
8071	"DATA",900 2313.93,27 4,0)
8072	P8^DUR/PPS Code Coun ter Out Of Sequence
8073	"DATA",900 2313.93,27 5,0)
8074	P9^Field I s Non-Repe atable
8075	"DATA",900 2313.93,27 6,0)
8076	RA^PA Reve rsal Out O f Order
8077	"DATA",900 2313.93,27 7,0)
8078	RB^Multipl e Partials Not Allow ed
8079	"DATA",900 2313.93,27 8,0)
8080	RC^Differe nt Drug En tity Betwe en Partial & Complet ion
8081	"DATA",900 2313.93,27 9,0)
8082	RD^Mismatc hed Cardho lder/Group ID-Partia l To Compl etion
8083	"DATA",900 2313.93,28 0,0)
8084	RE^M/I Com pound Prod uct ID Qua lifier
8085	"DATA",900 2313.93,28 1,0)
8086	RF^Imprope r Order Of 'Dispensi ng Status' Code On P artial Fil l Transact ion
8087	"DATA",900 2313.93,28 2,0)
8088	RG^M/I Ass ociated Rx /Service R eference # On Comple tion Trans action
8089	"DATA",900 2313.93,28 3,0)
8090	RH^M/I Ass ociated Pr escription /Service D ate On Com pletion Tr ansaction
8091	"DATA",900 2313.93,28 4,0)
8092	RJ^Associa ted Partia l Fill Tra nsaction N ot On File
8093	"DATA",900 2313.93,28 5,0)
8094	RK^Partial Fill Tran saction No t Supporte d
8095	"DATA",900 2313.93,28 6,0)
8096	RM^Compl T rans Not P ermitted W ith Same ' Date Of Se rvice' As Partial Tr ans
8097	"DATA",900 2313.93,28 7,0)
8098	RN^Plan Li mits Excee ded On Int ended Part ial Fill F ield Limit ations
8099	"DATA",900 2313.93,28 8,0)
8100	RP^Out Of Sequence ' P' Reversa l On Parti al Fill Tr ansaction
8101	"DATA",900 2313.93,28 9,0)
8102	RS^M/I Ass ociated Pr escription /Service D ate On Par tial Trans action
8103	"DATA",900 2313.93,29 0,0)
8104	RT^M/I Ass ociated Pr escription /Service R eference N umber On P artial Tra ns
8105	"DATA",900 2313.93,29 1,0)
8106	RU^Mandato ry Element s Must Occ ur Before Optional D ata Elemen ts In Segm ent
8107	"DATA",900 2313.93,29 2,0)
8108	R1^Other A mount Clai med Submit ted Count Does Not M atch # of Repetition s
8109	"DATA",900 2313.93,29 3,0)
8110	R2^Other P ayer Rejec t Count Do es Not Mat ch Number Of Repetit ions
8111	"DATA",900 2313.93,29 4,0)
8112	R3^Procedu re Modifie r Code Cou nt Does No t Match Nu mber Of Re petitions
8113	"DATA",900 2313.93,29 5,0)
8114	R4^Procedu re Modifie r Code Inv alid For P roduct/Ser vice ID
8115	"DATA",900 2313.93,29 6,0)
8116	R5^Product /Service I D Must Be Zero When Product/Se rvice ID Q ual Equals 06
8117	"DATA",900 2313.93,29 7,0)
8118	R6^Product /Service N ot Appropr iate For T his Locati on
8119	"DATA",900 2313.93,29 8,0)
8120	R7^Repeati ng Segment Not Allow ed In Same Transacti on
8121	"DATA",900 2313.93,29 9,0)
8122	R8^Syntax Error
8123	"DATA",900 2313.93,30 0,0)
8124	R9^Value I n Gross Am ount Due D oes Not Fo llow Prici ng Formula e
8125	"DATA",900 2313.93,30 1,0)
8126	SE^M/I Pro cedure Mod ifier Code Count
8127	"DATA",900 2313.93,30 2,0)
8128	TE^Missing /Invalid C ompound Pr oduct ID
8129	"DATA",900 2313.93,30 3,0)
8130	UE^M/I Com pound Ingr edient Bas is Of Cost Determina tion
8131	"DATA",900 2313.93,30 4,0)
8132	VE^M/I Dia gnosis Cod e Count
8133	"DATA",900 2313.93,30 5,0)
8134	WE^M/I Dia gnosis Cod e Qualifie r
8135	"DATA",900 2313.93,30 6,0)
8136	XE^M/I Cli nical Info rmation Co unter
8137	"DATA",900 2313.93,30 7,0)
8138	ZE^M/I Mea surement D ate
8139	"DATA",900 2313.93,30 8,0)
8140	*95^The Cl earinghous did not r espond in time
8141	"DATA",900 2313.93,30 9,0)
8142	*96^Schedu led Downti me
8143	"DATA",900 2313.93,31 0,0)
8144	*97^Payor Unavailabl e
8145	"DATA",900 2313.93,31 1,0)
8146	*98^Connec tion To Pa yer Is Dow n
8147	"DATA",900 2313.93,31 2,0)
8148	*95^The Cl earinghous e Did Not Respond In Time.
8149	"DATA",900 2313.93,31 3,0)
8150	*97^Payer Unavailabl e
8151	"DATA",900 2313.93,31 4,0)
8152	1R^Version /Release V alue Not S upported
8153	"DATA",900 2313.93,31 5,0)
8154	1S^Transac tion Code/ Type Value Not Suppo rted
8155	"DATA",900 2313.93,31 6,0)
8156	1T^PCN Mus t Contain Processor/ Payer Assi gned Value
8157	"DATA",900 2313.93,31 7,0)
8158	1U^Transac tion Count Does Not Match Numb er of Tran sactions
8159	"DATA",900 2313.93,31 8,0)
8160	1V^Multipl e Transact ions Not S upported
8161	"DATA",900 2313.93,31 9,0)
8162	1W^Multi-I ngredient Compound M ust Be A S ingle Tran saction
8163	"DATA",900 2313.93,32 0,0)
8164	1X^Vendor Not Certif ied For Pr ocessor/Pa yer
8165	"DATA",900 2313.93,32 1,0)
8166	1Y^Claim S egment Req uired For Adjudicati on
8167	"DATA",900 2313.93,32 2,0)
8168	1Z^Clinica l Segment Required F or Adjudic ation
8169	"DATA",900 2313.93,32 3,0)
8170	2A^M/I Med igap ID
8171	"DATA",900 2313.93,32 4,0)
8172	2B^M/I Med icaid Indi cator
8173	"DATA",900 2313.93,32 5,0)
8174	2D^M/I Pro vider Acce pt Assignm ent Indica tor
8175	"DATA",900 2313.93,32 6,0)
8176	2G^M/I Com pound Ingr edient Mod ifier Code Count
8177	"DATA",900 2313.93,32 7,0)
8178	2H^M/I Com pound Ingr edient Mod ifier Code
8179	"DATA",900 2313.93,32 8,0)
8180	2J^M/I Pre scriber Fi rst Name
8181	"DATA",900 2313.93,32 9,0)
8182	2K^M/I Pre scriber St reet Addre ss
8183	"DATA",900 2313.93,33 0,0)
8184	2M^M/I Pre scriber Ci ty Address
8185	"DATA",900 2313.93,33 1,0)
8186	2N^M/I Pre scriber St ate/Provin ce Address
8187	"DATA",900 2313.93,33 2,0)
8188	2P^M/I Pre scriber Zi p/Postal Z one
8189	"DATA",900 2313.93,33 3,0)
8190	2Q^M/I Add itional Do cumentatio n Type ID
8191	"DATA",900 2313.93,33 4,0)
8192	2R^M/I Len gth of Nee d
8193	"DATA",900 2313.93,33 5,0)
8194	2S^M/I Len gth of Nee d Qualifie r
8195	"DATA",900 2313.93,33 6,0)
8196	2T^M/I Pre scriber/Su pplier Dat e Signed
8197	"DATA",900 2313.93,33 7,0)
8198	2U^M/I Req uest Statu s
8199	"DATA",900 2313.93,33 8,0)
8200	2V^M/I Req uest Perio d Begin Da te
8201	"DATA",900 2313.93,33 9,0)
8202	2W^M/I Req uest Perio d Recert/R evised Dat e
8203	"DATA",900 2313.93,34 0,0)
8204	2X^M/I Sup porting Do cumentatio n
8205	"DATA",900 2313.93,34 1,0)
8206	2Z^M/I Que stion Numb er/Letter Count
8207	"DATA",900 2313.93,34 2,0)
8208	3Q^M/I Fac ility Name
8209	"DATA",900 2313.93,34 3,0)
8210	3U^M/I Fac ility Stre et Address
8211	"DATA",900 2313.93,34 4,0)
8212	3V^M/I Fac ility Stat e/Province Address
8213	"DATA",900 2313.93,34 5,0)
8214	4B^M/I Que stion Numb er/Letter
8215	"DATA",900 2313.93,34 6,0)
8216	4D^M/I Que stion Perc ent Respon se
8217	"DATA",900 2313.93,34 7,0)
8218	4G^M/I Que stion Date Response
8219	"DATA",900 2313.93,34 8,0)
8220	4H^M/I Que stion Doll ar Amount Response
8221	"DATA",900 2313.93,34 9,0)
8222	4J^M/I Que stion Nume ric Respon se
8223	"DATA",900 2313.93,35 0,0)
8224	4K^M/I Que stion Alph anumeric R esponse
8225	"DATA",900 2313.93,35 1,0)
8226	4M^Compoun d Ingredie nt Modifie r Code Cou nt Doesn't Match # o f Repetiti ons
8227	"DATA",900 2313.93,35 2,0)
8228	4N^Questio n Number/L etter Coun t Does Not Match Num ber of Rep etitions
8229	"DATA",900 2313.93,35 3,0)
8230	4P^Questio n Number/L etter Not Valid for Identified Document
8231	"DATA",900 2313.93,35 4,0)
8232	4Q^Questio n Response Not Appro priate for Question Number/Let ter
8233	"DATA",900 2313.93,35 5,0)
8234	4R^Require d Question Num/Lette r Response for Indic ated Docum ent Missin g
8235	"DATA",900 2313.93,35 6,0)
8236	4S^Compoun d Product ID Require s a Modifi er Code
8237	"DATA",900 2313.93,35 7,0)
8238	4T^M/I Add itional Do cumentatio n Segment
8239	"DATA",900 2313.93,35 8,0)
8240	4W^Must Fi ll Through Specialty Pharmacy
8241	"DATA",900 2313.93,35 9,0)
8242	4X^M/I Pat ient Resid ence
8243	"DATA",900 2313.93,36 0,0)
8244	4Y^Patient Residence Value Not Supported
8245	"DATA",900 2313.93,36 1,0)
8246	4Z^Place o f Service Not Suppor ted By Pla n
8247	"DATA",900 2313.93,36 2,0)
8248	5J^M/I Fac ility City Address
8249	"DATA",900 2313.93,36 3,0)
8250	6D^M/I Fac ility Zip/ Postal Zon e
8251	"DATA",900 2313.93,36 4,0)
8252	6G^COB/Oth er Payment s Segment Required F or Adjudic ation
8253	"DATA",900 2313.93,36 5,0)
8254	6H^Coupon Segment Re quired For Adjudicat ion
8255	"DATA",900 2313.93,36 6,0)
8256	6J^Insuran ce Segment Required For Adjudi cation
8257	"DATA",900 2313.93,36 7,0)
8258	6K^Patient Segment R equired Fo r Adjudica tion
8259	"DATA",900 2313.93,36 8,0)
8260	6M^Pharmac y Provider Segment R equired Fo r Adjudica tion
8261	"DATA",900 2313.93,36 9,0)
8262	6N^Prescri ber Segmen t Required For Adjud ication
8263	"DATA",900 2313.93,37 0,0)
8264	6P^Pricing Segment R equired Fo r Adjudica tion
8265	"DATA",900 2313.93,37 1,0)
8266	6Q^Prior A uthorizati on Segment Required For Adjudi cation
8267	"DATA",900 2313.93,37 2,0)
8268	6R^Worker' s Compensa tion Segme nt Require d For Adju dication
8269	"DATA",900 2313.93,37 3,0)
8270	6S^Transac tion Segme nt Require d For Adju dication
8271	"DATA",900 2313.93,37 4,0)
8272	6T^Compoun d Segment Required F or Adjudic ation
8273	"DATA",900 2313.93,37 5,0)
8274	6U^Compoun d Segment Incorrectl y Formatte d
8275	"DATA",900 2313.93,37 6,0)
8276	6V^Multi-i ngredient Compounds Not Suppor ted
8277	"DATA",900 2313.93,37 7,0)
8278	6W^DUR/PPS Segment R equired Fo r Adjudica tion
8279	"DATA",900 2313.93,37 8,0)
8280	6X^DUR/PPS Segment I ncorrectly Formatted
8281	"DATA",900 2313.93,37 9,0)
8282	6Y^Not Aut horized To Submit El ectronical ly
8283	"DATA",900 2313.93,38 0,0)
8284	6Z^Provide r Not Elig ible To Pe rform Serv ice/Dispen se Product
8285	"DATA",900 2313.93,38 1,0)
8286	7A^Provide r Does Not Match Aut horization On File
8287	"DATA",900 2313.93,38 2,0)
8288	7B^Service Provider ID Qualifi er Value N ot Support ed For Pro cessor/Pay er
8289	"DATA",900 2313.93,38 3,0)
8290	7D^Non-Mat ched DOB
8291	"DATA",900 2313.93,38 4,0)
8292	7G^Future Date Not A llowed For DOB
8293	"DATA",900 2313.93,38 5,0)
8294	7H^Non-Mat ched Gende r Code
8295	"DATA",900 2313.93,38 6,0)
8296	7J^Patient Relations hip Code V alue Not S upported
8297	"DATA",900 2313.93,38 7,0)
8298	7K^Discrep ancy Betwe en Other C overage Co de And Oth er Payer A mount
8299	"DATA",900 2313.93,38 8,0)
8300	7M^Discrep ancy Betwe en Other C overage Co de & Other Coverage Info On Fi le
8301	"DATA",900 2313.93,38 9,0)
8302	7N^Patient ID Qualif ier Value Not Suppor ted
8303	"DATA",900 2313.93,39 0,0)
8304	7P^COB/Oth er Payment s Count Ex ceeds Numb er of Supp orted Paye rs
8305	"DATA",900 2313.93,39 1,0)
8306	7Q^Other P ayer ID Qu alifier Va lue Not Su pported
8307	"DATA",900 2313.93,39 2,0)
8308	7R^Other P ayer Amoun t Paid Cou nt Exceeds Number of Supported Groupings
8309	"DATA",900 2313.93,39 3,0)
8310	7S^Other P ayer Amoun t Paid Qua lifier Val ue Not Sup ported
8311	"DATA",900 2313.93,39 4,0)
8312	7T^Quantit y Intended To Be Dis pensed Req uired For Partial Fi ll Trans
8313	"DATA",900 2313.93,39 5,0)
8314	7U^Days Su pply Inten ded To Be Dispensed Required F or Partial Fill Tran s
8315	"DATA",900 2313.93,39 6,0)
8316	7V^Duplica te Refills
8317	"DATA",900 2313.93,39 7,0)
8318	7W^Refills Exceed al lowable Re fills
8319	"DATA",900 2313.93,39 8,0)
8320	7X^Days Su pply Excee ds Plan Li mitation
8321	"DATA",900 2313.93,39 9,0)
8322	7Y^Compoun ds Not Cov ered
8323	"DATA",900 2313.93,40 0,0)
8324	7Z^Compoun d Requires Two Or Mo re Ingredi ents
8325	"DATA",900 2313.93,40 1,0)
8326	8A^Compoun d Requires At Least One Covere d Ingredie nt
8327	"DATA",900 2313.93,40 2,0)
8328	8B^Compoun d Segment Missing On A Compoun d Claim
8329	"DATA",900 2313.93,40 3,0)
8330	8D^Compoun d Segment Present On A Non-Com pound Clai m
8331	"DATA",900 2313.93,40 4,0)
8332	8G^Product /Service I D (407-D7) Must Be A Single Ze ro '0' For Compounds
8333	"DATA",900 2313.93,40 5,0)
8334	8H^Product /Service O nly Covere d On Compo und Claim
8335	"DATA",900 2313.93,40 6,0)
8336	8J^Incorre ct Product /Service I D For Proc essor/Paye r
8337	"DATA",900 2313.93,40 7,0)
8338	8K^DAW Cod e Value No t Supporte d
8339	"DATA",900 2313.93,40 8,0)
8340	8M^Sum Of Compound I ngredient Costs Does Not Equal Ingredien t Cost
8341	"DATA",900 2313.93,40 9,0)
8342	8N^Future Date Presc ription Wr itten Not Allowed
8343	"DATA",900 2313.93,41 0,0)
8344	8P^Date Wr itten Diff erent On P revious Fi lling
8345	"DATA",900 2313.93,41 1,0)
8346	8Q^Excessi ve Refills Authorize d
8347	"DATA",900 2313.93,41 2,0)
8348	8R^Submiss ion Clarif ication Co de Value N ot Support ed
8349	"DATA",900 2313.93,41 3,0)
8350	8S^Basis O f Cost Det ermination Value Not Supported
8351	"DATA",900 2313.93,41 4,0)
8352	8T^U&C Mus t Be Great er Than Ze ro
8353	"DATA",900 2313.93,41 5,0)
8354	8U^GAD Mus t Be Great er Than Ze ro
8355	"DATA",900 2313.93,41 6,0)
8356	8V^Negativ e Dollar A mount Is N ot Support ed In Othe r Payer Am ount Paid
8357	"DATA",900 2313.93,41 7,0)
8358	8W^Discrep ancy Betwe en Other C overage Co de and Oth er Payer A mount Paid
8359	"DATA",900 2313.93,41 8,0)
8360	8X^Collect ion From C ardholder Not Allowe d
8361	"DATA",900 2313.93,41 9,0)
8362	8Y^Excessi ve Amount Collected
8363	"DATA",900 2313.93,42 0,0)
8364	8Z^Product /Service I D Qualifie r Value No t Supporte d
8365	"DATA",900 2313.93,42 1,0)
8366	9B^Reason For Servic e Code Val ue Not Sup ported
8367	"DATA",900 2313.93,42 2,0)
8368	9C^Profess ional Serv ice Code V alue Not S upported
8369	"DATA",900 2313.93,42 3,0)
8370	9D^Result Of Service Code Valu e Not Supp orted
8371	"DATA",900 2313.93,42 4,0)
8372	9E^Quantit y Does Not Match Dis pensing Un it
8373	"DATA",900 2313.93,42 5,0)
8374	9G^Quantit y Dispense d Exceeds Maximum Al lowed
8375	"DATA",900 2313.93,42 6,0)
8376	9H^Quantit y Not Vali d For Prod uct/Servic e ID Submi tted
8377	"DATA",900 2313.93,42 7,0)
8378	9J^Future Other Paye r Date Not Allowed
8379	"DATA",900 2313.93,42 8,0)
8380	9K^Compoun d Ingredie nt Compone nt Cnt Exc eeds Num O f Ingredie nts Suppor ted
8381	"DATA",900 2313.93,42 9,0)
8382	9M^Minimum Of Two In gredients Required
8383	"DATA",900 2313.93,43 0,0)
8384	9N^Compoun d Ingredie nt Quantit y Exceeds Maximum Al lowed
8385	"DATA",900 2313.93,43 1,0)
8386	9P^Compoun d Ingredie nt Drug Co st Must Be Greater T han Zero
8387	"DATA",900 2313.93,43 2,0)
8388	9Q^Route O f Administ ration Sub mitted Not Covered
8389	"DATA",900 2313.93,43 3,0)
8390	9R^Prescri ption/Serv ice Refere nce Number Qualifier Submitted Not Cover ed
8391	"DATA",900 2313.93,43 4,0)
8392	9S^Future Associated Prescript ion/Servic e Date Not Allowed
8393	"DATA",900 2313.93,43 5,0)
8394	9T^Prior A uthorizati on Type Co de Submitt ed Not Cov ered
8395	"DATA",900 2313.93,43 6,0)
8396	9U^Provide r ID Quali fier Submi tted Not C overed
8397	"DATA",900 2313.93,43 7,0)
8398	9V^Prescri ber ID Qua lifier Sub mitted Not Covered
8399	"DATA",900 2313.93,43 8,0)
8400	9W^DUR/PPS Code Coun ter Exceed s Number O f Occurren ces Suppor ted
8401	"DATA",900 2313.93,43 9,0)
8402	9X^Coupon Type Submi tted Not C overed
8403	"DATA",900 2313.93,44 0,0)
8404	9Y^Compoun d Product ID Qualifi er Submitt ed Not Cov ered
8405	"DATA",900 2313.93,44 1,0)
8406	9Z^Duplica te Product ID In Com pound
8407	"DATA",900 2313.93,44 2,0)
8408	AQ^M/I Fac ility Segm ent
8409	"DATA",900 2313.93,44 3,0)
8410	A5^Not Cov ered Under Part D La w
8411	"DATA",900 2313.93,44 4,0)
8412	A6^This Pr oduct/Serv ice May Be Covered U nder Medic are Part B
8413	"DATA",900 2313.93,44 5,0)
8414	A7^M/I Int ernal Cont rol Number
8415	"DATA",900 2313.93,44 6,0)
8416	BA^Compoun d Basis of Cost Dete rmination Submitted Not Covere d
8417	"DATA",900 2313.93,44 7,0)
8418	BB^Diagnos is Code Qu alifier Su bmitted No t Covered
8419	"DATA",900 2313.93,44 8,0)
8420	BC^Future Measuremen t Date Not Allowed
8421	"DATA",900 2313.93,44 9,0)
8422	BD^Sender Not Author ized To Su bmit File Type
8423	"DATA",900 2313.93,45 0,0)
8424	BF^M/I Fil e Type
8425	"DATA",900 2313.93,45 1,0)
8426	BG^Sender ID Not Cer tified For Processor /Payer
8427	"DATA",900 2313.93,45 2,0)
8428	BH^M/I Sen der ID
8429	"DATA",900 2313.93,45 3,0)
8430	BJ^Transmi ssion Type Submitted Not Suppo rted
8431	"DATA",900 2313.93,45 4,0)
8432	BK^M/I Tra nsmission Type
8433	"DATA",900 2313.93,45 5,0)
8434	BM^M/I Nar rative Mes sage
8435	"DATA",900 2313.93,45 6,0)
8436	EP^M/I Ass ociated Pr escription /Service D ate
8437	"DATA",900 2313.93,45 7,0)
8438	G1^M/I Com pound Type
8439	"DATA",900 2313.93,45 8,0)
8440	G2^M/I CMS Part D De fined Qual ified Faci lity
8441	"DATA",900 2313.93,45 9,0)
8442	G4^Physici an must co ntact plan
8443	"DATA",900 2313.93,46 0,0)
8444	G5^Pharmac ist must c ontact pla n
8445	"DATA",900 2313.93,46 1,0)
8446	G6^Pharmac y Not Cont racted in Specialty Network
8447	"DATA",900 2313.93,46 2,0)
8448	G7^Pharmac y Not Cont racted in Home Infus ion Networ k
8449	"DATA",900 2313.93,46 3,0)
8450	G8^Pharmac y Not Cont racted in Long Term Care Netwo rk
8451	"DATA",900 2313.93,46 4,0)
8452	G9^Pharmac y Not Cont racted in 90 Day Ret ail Networ k
8453	"DATA",900 2313.93,46 5,0)
8454	HN^M/I Pat ient E-Mai l Address
8455	"DATA",900 2313.93,46 6,0)
8456	K5^M/I Tra nsaction R eference N umber
8457	"DATA",900 2313.93,46 7,0)
8458	MG^M/I Oth er Payer B IN Number
8459	"DATA",900 2313.93,46 8,0)
8460	MH^M/I Oth er Payer P rocessor C ontrol Num ber
8461	"DATA",900 2313.93,46 9,0)
8462	MJ^M/I Oth er Payer G roup ID
8463	"DATA",900 2313.93,47 0,0)
8464	MK^Non-Mat ched Other Payer BIN Number
8465	"DATA",900 2313.93,47 1,0)
8466	MM^Non-Mat ched Other Payer Pro cessor Con trol Numbe r
8467	"DATA",900 2313.93,47 2,0)
8468	MN^Non-Mat ched Other Payer Gro up ID
8469	"DATA",900 2313.93,47 3,0)
8470	MP^Other P ayer Cardh older ID N ot Covered
8471	"DATA",900 2313.93,47 4,0)
8472	MR^Product Not On Fo rmulary
8473	"DATA",900 2313.93,47 5,0)
8474	MS^More th an 1 Cardh older Foun d - Narrow Search Cr iteria
8475	"DATA",900 2313.93,47 6,0)
8476	MT^M/I Pat ient Assig nment Indi cator
8477	"DATA",900 2313.93,47 7,0)
8478	MU^M/I Ben efit Stage Count
8479	"DATA",900 2313.93,47 8,0)
8480	MV^M/I Ben efit Stage Qualifier
8481	"DATA",900 2313.93,47 9,0)
8482	MW^M/I Ben efit Stage Amount
8483	"DATA",900 2313.93,48 0,0)
8484	MX^Benefit Stage Cou nt Does No t Match Nu mber Of Re petitions
8485	"DATA",900 2313.93,48 1,0)
8486	NP^M/I Oth er Payer-P atient Res ponsibilit y Amount Q ualifier
8487	"DATA",900 2313.93,48 2,0)
8488	NQ^M/I Oth er Payer-P atient Res ponsibilit y Amount
8489	"DATA",900 2313.93,48 3,0)
8490	NR^M/I Oth er Payer-P atient Res ponsibilit y Amount C ount
8491	"DATA",900 2313.93,48 4,0)
8492	NU^M/I Oth er Payer C ardholder ID
8493	"DATA",900 2313.93,48 5,0)
8494	NV^M/I Del ay Reason Code
8495	"DATA",900 2313.93,48 6,0)
8496	NX^M/I Sub mission Cl arificatio n Code Cou nt
8497	"DATA",900 2313.93,48 7,0)
8498	N1^No pati ent match found
8499	"DATA",900 2313.93,48 8,0)
8500	N3^M/I Med icaid Paid Amount
8501	"DATA",900 2313.93,48 9,0)
8502	N4^M/I Med icaid Subr ogation In ternal Ctr l Number/T ransaction Ctrl Numb er
8503	"DATA",900 2313.93,49 0,0)
8504	N5^M/I Med icaid ID N umber
8505	"DATA",900 2313.93,49 1,0)
8506	N6^M/I Med icaid Agen cy Number
8507	"DATA",900 2313.93,49 2,0)
8508	N7^Use Pri or Authori zation ID Provided D uring Tran sition Per iod
8509	"DATA",900 2313.93,49 3,0)
8510	N8^Use Pri or Authori zation ID Provided F or Emergen cy Fill
8511	"DATA",900 2313.93,49 4,0)
8512	N9^Use Pri or Authori zation ID Provided F or Level o f Care Cha nge
8513	"DATA",900 2313.93,49 5,0)
8514	PQ^M/I Nar rative Seg ment
8515	"DATA",900 2313.93,49 6,0)
8516	RL^Transit ional Bene fit/Resubm it Claim
8517	"DATA",900 2313.93,49 7,0)
8518	RV^Multipl e Reversal s Per Tran smission N ot Support ed
8519	"DATA",900 2313.93,49 8,0)
8520	SF^Other P ayer Amoun t Paid Cou nt Does No t Match Nu mber Of Re petitions
8521	"DATA",900 2313.93,49 9,0)
8522	SG^Submiss ion Clarif ication Co de Count D oesn't Mat ch # of Re petitions
8523	"DATA",900 2313.93,50 0,0)
8524	SH^Other P ayer-Patie nt Resp Am ount Count Doesn't M atch # of Repetition s
8525	"DATA",900 2313.93,50 1,0)
8526	TN^Emergen cy Fill/Re submit Cla im
8527	"DATA",900 2313.93,50 2,0)
8528	TP^Level o f Care Cha nge/Resubm it Claim
8529	"DATA",900 2313.93,50 3,0)
8530	TQ^Dosage Exceeds Pr oduct Labe ling Limit
8531	"DATA",900 2313.93,50 4,0)
8532	TR^M/I Bil ling Entit y Type Ind icator
8533	"DATA",900 2313.93,50 5,0)
8534	TS^M/I Pay To Qualif ier
8535	"DATA",900 2313.93,50 6,0)
8536	TT^M/I Pay To ID
8537	"DATA",900 2313.93,50 7,0)
8538	TU^M/I Pay To Name
8539	"DATA",900 2313.93,50 8,0)
8540	TV^M/I Pay To Street Address
8541	"DATA",900 2313.93,50 9,0)
8542	TW^M/I Pay To City A ddress
8543	"DATA",900 2313.93,51 0,0)
8544	TX^M/I Pay to State/ Province A ddress
8545	"DATA",900 2313.93,51 1,0)
8546	TY^M/I Pay To Zip/Po stal Zone
8547	"DATA",900 2313.93,51 2,0)
8548	TZ^M/I Gen eric Equiv alent Prod uct ID Qua lifier
8549	"DATA",900 2313.93,51 3,0)
8550	UA^M/I Gen eric Equiv alent Prod uct ID
8551	"DATA",900 2313.93,51 4,0)
8552	UU^DAW 0 c annot be s ubmitted o n a multi- source dru g w/availa ble generi cs
8553	"DATA",900 2313.93,51 5,0)
8554	UZ^Other P ayer Cover age Type r equired on reversals to downst ream payer s
8555	"DATA",900 2313.93,51 6,0)
8556	U7^M/I Pha rmacy Serv ice Type
8557	"DATA",900 2313.93,51 7,0)
8558	VA^Pay To Qualifier Value Not Supported
8559	"DATA",900 2313.93,51 8,0)
8560	VB^Generic Equivalen t Product ID Qualifi er Value N ot Support ed
8561	"DATA",900 2313.93,51 9,0)
8562	VC^Pharmac y Service Type Value Not Suppo rted
8563	"DATA",900 2313.93,52 0,0)
8564	VD^Eligibi lity Searc h Time Fra me Exceede d
8565	"DATA",900 2313.93,52 1,0)
8566	ZA^The COB /Other Pay ments Segm ent is man datory to a downstre am payer
8567	"DATA",900 2313.93,52 2,0)
8568	eT^TRICARE -DRUG NON BILLABLE
8569	"DATA",900 2313.93,52 3,0)
8570	MY^M/I Add ress Count
8571	"DATA",900 2313.93,52 4,0)
8572	NA^M/I Add ress Quali fier
8573	"DATA",900 2313.93,52 5,0)
8574	NB^M/I Cli ent Name
8575	"DATA",900 2313.93,52 6,0)
8576	NC^M/I Dis continue D ate Qualif ier
8577	"DATA",900 2313.93,52 7,0)
8578	ND^M/I Dis continue D ate
8579	"DATA",900 2313.93,52 8,0)
8580	NF^M/I Eas y Open Cap Indicator
8581	"DATA",900 2313.93,52 9,0)
8582	NG^M/I Eff ective Dat e
8583	"DATA",900 2313.93,53 0,0)
8584	NH^M/I Exp iration Da te
8585	"DATA",900 2313.93,53 1,0)
8586	NJ^M/I Fil e Structur e Type
8587	"DATA",900 2313.93,53 2,0)
8588	NK^M/I Ina ctive Pres cription I ndicator
8589	"DATA",900 2313.93,53 3,0)
8590	NM^M/I Lab el Directi ons
8591	"DATA",900 2313.93,53 4,0)
8592	NW^M/I Mos t Recent D ate Filled
8593	"DATA",900 2313.93,53 5,0)
8594	NY^M/I Num ber Of Fil ls To-Date
8595	"DATA",900 2313.93,53 6,0)
8596	PU^M/I Num ber Of Fil ls Remaini ng
8597	"DATA",900 2313.93,53 7,0)
8598	P0^Non-zer o Value Re quired for Vaccine A dministrat ion
8599	"DATA",900 2313.93,53 8,0)
8600	RQ^M/I Ori ginal Disp ensed Date
8601	"DATA",900 2313.93,53 9,0)
8602	RR^M/I Pat ient ID Qu alifier Co unt
8603	"DATA",900 2313.93,54 0,0)
8604	RW^M/I Pre scribed Dr ug Descrip tion
8605	"DATA",900 2313.93,54 1,0)
8606	RX^M/I Pre scriber ID Count
8607	"DATA",900 2313.93,54 2,0)
8608	RY^M/I Pre scriber Sp ecialty
8609	"DATA",900 2313.93,54 3,0)
8610	RZ^M/I Pre scriber Sp ecialty Co unt
8611	"DATA",900 2313.93,54 4,0)
8612	R0^Profess ional Serv Cd of 'MA ' req'd fo r Vaccine Incentive Fee Submit ted
8613	"DATA",900 2313.93,54 5,0)
8614	S0^Accumul ator Month Count Doe s Not Matc h Number o f Repetiti ons
8615	"DATA",900 2313.93,54 6,0)
8616	S1^M/I Acc umulator Y ear
8617	"DATA",900 2313.93,54 7,0)
8618	S2^M/I Tra nsaction I dentifier
8619	"DATA",900 2313.93,54 8,0)
8620	S3^M/I Acc umulated P atient Tru e Out Of P ocket Amou nt
8621	"DATA",900 2313.93,54 9,0)
8622	S4^M/I Acc umulated G ross Cover ed Drug Co st Amount
8623	"DATA",900 2313.93,55 0,0)
8624	S5^M/I Dat eTime
8625	"DATA",900 2313.93,55 1,0)
8626	S6^M/I Acc umulator M onth
8627	"DATA",900 2313.93,55 2,0)
8628	S7^M/I Acc umulator M onth Count
8629	"DATA",900 2313.93,55 3,0)
8630	S8^Non-Mat ched Trans action Ide ntifier
8631	"DATA",900 2313.93,55 4,0)
8632	S9^M/I Fin ancial Inf ormation R eporting T ransaction Header Se gment
8633	"DATA",900 2313.93,55 5,0)
8634	SA^M/I Qua ntity Disp ensed To D ate
8635	"DATA",900 2313.93,55 6,0)
8636	SB^M/I Rec ord Delimi ter
8637	"DATA",900 2313.93,55 7,0)
8638	SC^M/I Rem aining Qua ntity
8639	"DATA",900 2313.93,55 8,0)
8640	SD^M/I Sen der Name
8641	"DATA",900 2313.93,55 9,0)
8642	SJ^M/I Tot al Number Of Sending And Recei ving Pharm acy Record s
8643	"DATA",900 2313.93,56 0,0)
8644	SK^M/I Tra nsfer Flag
8645	"DATA",900 2313.93,56 1,0)
8646	SM^M/I Tra nsfer Type
8647	"DATA",900 2313.93,56 2,0)
8648	SN^M/I Pac kage Acqui sition Cos t
8649	"DATA",900 2313.93,56 3,0)
8650	SP^M/I Uni que Record Identifie r
8651	"DATA",900 2313.93,56 4,0)
8652	SQ^M/I Uni que Record Identifie r Qualifie r
8653	"DATA",900 2313.93,56 5,0)
8654	SW^Accum P atient Tru e Out of P ocket must be equal to or grea ter than z ero
8655	"DATA",900 2313.93,56 6,0)
8656	TD^M/I Pha rmacist In itials
8657	"DATA",900 2313.93,56 7,0)
8658	TG^Address Count Doe s Not Matc h Number O f Repetiti ons
8659	"DATA",900 2313.93,56 8,0)
8660	TH^Patient ID Qualif ier Count Does Not M atch Numbe r Of Repet itions
8661	"DATA",900 2313.93,56 9,0)
8662	TJ^Prescri ber ID Cou nt Does No t Match Nu mber Of Re petitions
8663	"DATA",900 2313.93,57 0,0)
8664	TK^Prescri ber Specia lty Count Does Not M atch Numbe r Of Repet itions
8665	"DATA",900 2313.93,57 1,0)
8666	TM^Telepho ne Number Count Does Not Match Number Of Repetitio ns
8667	"DATA",900 2313.93,57 2,0)
8668	T0^Accumul ator Month Count Exc eeds Numbe r of Occur rences Sup ported
8669	"DATA",900 2313.93,57 3,0)
8670	T1^Request Financial Segment R equired Fo r Financia l Informat ion Report ing
8671	"DATA",900 2313.93,57 4,0)
8672	T2^M/I Req uest Refer ence Segme nt
8673	"DATA",900 2313.93,57 5,0)
8674	T3^Out of Order Date Time
8675	"DATA",900 2313.93,57 6,0)
8676	T4^Duplica te DateTim e
8677	"DATA",900 2313.93,57 7,0)
8678	U0^M/I Sen ding Pharm acy ID
8679	"DATA",900 2313.93,57 8,0)
8680	V0^M/I Tel ephone Num ber Count
8681	"DATA",900 2313.93,57 9,0)
8682	W0^M/I Tel ephone Num ber Qualif ier
8683	"DATA",900 2313.93,58 0,0)
8684	W5^M/I Bed
8685	"DATA",900 2313.93,58 1,0)
8686	W6^M/I Fac ility Unit
8687	"DATA",900 2313.93,58 2,0)
8688	W7^M/I Hou rs of Admi nistration
8689	"DATA",900 2313.93,58 3,0)
8690	W8^M/I Roo m
8691	"DATA",900 2313.93,58 4,0)
8692	W9^Accum G ross Cov D rug Cost A mt Must Be Equal To Or Greater Than Zero
8693	"DATA",900 2313.93,58 5,0)
8694	X1^Accumul ated Patie nt True Ou t of Pocke t exceeds maximum
8695	"DATA",900 2313.93,58 6,0)
8696	X2^Accumul ated Gross Covered D rug Cost e xceeds max imum
8697	"DATA",900 2313.93,58 7,0)
8698	X3^Out of order Accu mulator Mo nths
8699	"DATA",900 2313.93,58 8,0)
8700	X4^Accumul ator Year not curren t or prior year
8701	"DATA",900 2313.93,58 9,0)
8702	X5^M/I Fin ancial Inf ormation R eporting R equest Ins urance Seg ment
8703	"DATA",900 2313.93,59 0,0)
8704	X6^M/I Req uest Finan cial Segme nt
8705	"DATA",900 2313.93,59 1,0)
8706	X7^Financi al Info Re porting Re q Ins Seg Required F or Financi al Reporti ng
8707	"DATA",900 2313.93,59 2,0)
8708	X8^Procedu re Modifie r Code Cou nt Exceeds Number Of Occurrenc es Support ed
8709	"DATA",900 2313.93,59 3,0)
8710	X9^Diagnos is Code Co unt Exceed s Number O f Occurren ces Suppor ted
8711	"DATA",900 2313.93,59 4,0)
8712	YA^Compoun d Ingredie nt Mod Cod e Cnt Exce eds Num Of Occurrenc es Support ed
8713	"DATA",900 2313.93,59 5,0)
8714	YB^Other A mt Claimed Submitted Count Exc eeds Num O f Occurren ces Suppor ted
8715	"DATA",900 2313.93,59 6,0)
8716	YC^Other P ayer Rejec t Count Ex ceeds Numb er Of Occu rrences Su pported
8717	"DATA",900 2313.93,59 7,0)
8718	YD^Other P ayer-Patie nt Resp Am t Cnt Exce eds Num Of Occurrenc es Support ed
8719	"DATA",900 2313.93,59 8,0)
8720	YE^Submiss ion Clarif ication Co de Cnt Exc eeds Num o f Occurren ces Suppor ted
8721	"DATA",900 2313.93,59 9,0)
8722	YF^Questio n Number/L etter Coun t Exceeds Number Of Occurrence s Supporte d
8723	"DATA",900 2313.93,60 0,0)
8724	YG^Benefit Stage Cou nt Exceeds Number Of Occurrenc es Support ed
8725	"DATA",900 2313.93,60 1,0)
8726	YH^Clinica l Informat ion Counte r Exceeds Number of Occurrence s Supporte d
8727	"DATA",900 2313.93,60 2,0)
8728	YJ^Medicai d Agency N umber Not Supported
8729	"DATA",900 2313.93,60 3,0)
8730	201^Patien t Segment is not use d for this Transacti on Code
8731	"DATA",900 2313.93,60 4,0)
8732	202^Insura nce Segmen t is not u sed for th is Transac tion Code
8733	"DATA",900 2313.93,60 5,0)
8734	203^Claim Segment is not used for this T ransaction Code
8735	"DATA",900 2313.93,60 6,0)
8736	204^Pharma cy Provide r Segment is not use d for this Transacti on Code
8737	"DATA",900 2313.93,60 7,0)
8738	205^Prescr iber Segme nt is not used for t his Transa ction Code
8739	"DATA",900 2313.93,60 8,0)
8740	206^COB/Ot her Paymen ts Segment is not us ed for thi s Transact ion Code
8741	"DATA",900 2313.93,60 9,0)
8742	207^Worker s' Compens ation Segm ent is not used for this Trans action Cod e
8743	"DATA",900 2313.93,61 0,0)
8744	208^DUR/PP S Segment is not use d for this Transacti on Code
8745	"DATA",900 2313.93,61 1,0)
8746	209^Pricin g Segment is not use d for this Transacti on Code
8747	"DATA",900 2313.93,61 2,0)
8748	210^Coupon Segment i s not used for this Transactio n Code
8749	"DATA",900 2313.93,61 3,0)
8750	211^Compou nd Segment is not us ed for thi s Transact ion Code
8751	"DATA",900 2313.93,61 4,0)
8752	212^Prior Authorizat ion Segmen t is not u sed for th is Transac tion Code
8753	"DATA",900 2313.93,61 5,0)
8754	213^Clinic al Segment is not us ed for thi s Transact ion Code
8755	"DATA",900 2313.93,61 6,0)
8756	214^Additi onal Docum entation S egment is not used f or this Tr ansaction Code
8757	"DATA",900 2313.93,61 7,0)
8758	215^Facili ty Segment is not us ed for thi s Transact ion Code
8759	"DATA",900 2313.93,61 8,0)
8760	216^Narrat ive Segmen t is not u sed for th is Transac tion Code
8761	"DATA",900 2313.93,61 9,0)
8762	217^Purcha ser Segmen t is not u sed for th is Transac tion Code
8763	"DATA",900 2313.93,62 0,0)
8764	218^Servic e Provider Segment i s not used for this Transactio n Code
8765	"DATA",900 2313.93,62 1,0)
8766	219^Patien t ID Quali fier is no t used for this Tran saction Co de
8767	"DATA",900 2313.93,62 2,0)
8768	220^Patien t ID is no t used for this Tran saction Co de
8769	"DATA",900 2313.93,62 3,0)
8770	221^Date o f Birth is not used for this T ransaction Code
8771	"DATA",900 2313.93,62 4,0)
8772	222^Patien t Gender C ode is not used for this Trans action Cod e
8773	"DATA",900 2313.93,62 5,0)
8774	223^Patien t First Na me is not used for t his Transa ction Code
8775	"DATA",900 2313.93,62 6,0)
8776	224^Patien t Last Nam e is not u sed for th is Transac tion Code
8777	"DATA",900 2313.93,62 7,0)
8778	225^Patien t Street A ddress is not used f or this Tr ansaction Code
8779	"DATA",900 2313.93,62 8,0)
8780	226^Patien t City Add ress is no t used for this Tran saction Co de
8781	"DATA",900 2313.93,62 9,0)
8782	227^Patien t State/Pr ovince Add ress is no t used for this Tran saction Co de
8783	"DATA",900 2313.93,63 0,0)
8784	228^Patien t ZIP/Post al Zone is not used for this T ransaction Code
8785	"DATA",900 2313.93,63 1,0)
8786	229^Patien t Phone Nu mber is no t used for this Tran saction Co de
8787	"DATA",900 2313.93,63 2,0)
8788	230^Place of Service is not us ed for thi s Transact ion Code
8789	"DATA",900 2313.93,63 3,0)
8790	231^Employ er ID is n ot used fo r this Tra nsaction C ode
8791	"DATA",900 2313.93,63 4,0)
8792	232^Smoker /Non-Smoke r Code is not used f or this Tr ansaction Code
8793	"DATA",900 2313.93,63 5,0)
8794	233^Pregna ncy Indica tor is not used for this Trans action Cod e
8795	"DATA",900 2313.93,63 6,0)
8796	234^Patien t E-Mail A ddress is not used f or this Tr ansaction Code
8797	"DATA",900 2313.93,63 7,0)
8798	235^Patien t Residenc e is not u sed for th is Transac tion Code
8799	"DATA",900 2313.93,63 8,0)
8800	236^Patien t ID Assoc State/Pro vince Addr ess not us ed for thi s Trans Co de
8801	"DATA",900 2313.93,63 9,0)
8802	237^Cardho lder First Name is n ot used fo r this Tra nsaction C ode
8803	"DATA",900 2313.93,64 0,0)
8804	238^Cardho lder Last Name is no t used for this Tran saction Co de
8805	"DATA",900 2313.93,64 1,0)
8806	239^Home P lan is not used for this Trans action Cod e
8807	"DATA",900 2313.93,64 2,0)
8808	240^Plan I D is not u sed for th is Transac tion Code
8809	"DATA",900 2313.93,64 3,0)
8810	241^Eligib ility Clar ification Code is no t used for this Tran saction Co de
8811	"DATA",900 2313.93,64 4,0)
8812	242^Group ID is not used for t his Transa ction Code
8813	"DATA",900 2313.93,64 5,0)
8814	243^Person Code is n ot used fo r this Tra nsaction C ode
8815	"DATA",900 2313.93,64 6,0)
8816	244^Patien t Relation ship Code is not use d for this Transacti on Code
8817	"DATA",900 2313.93,64 7,0)
8818	245^Other Payer BIN Number is not used f or this Tr ansaction Code
8819	"DATA",900 2313.93,64 8,0)
8820	246^Other Payer Proc essor Cont rol Number is not us ed for thi s Trans Co de
8821	"DATA",900 2313.93,64 9,0)
8822	247^Other Payer Card holder ID is not use d for this Transacti on Code
8823	"DATA",900 2313.93,65 0,0)
8824	248^Other Payer Grou p ID is no t used for this Tran saction Co de
8825	"DATA",900 2313.93,65 1,0)
8826	249^Mediga p ID is no t used for this Tran saction Co de
8827	"DATA",900 2313.93,65 2,0)
8828	250^Medica id Indicat or is not used for t his Transa ction Code
8829	"DATA",900 2313.93,65 3,0)
8830	251^Provid er Accept Assignment Indicator is not us ed for thi s Trans Co de
8831	"DATA",900 2313.93,65 4,0)
8832	252^CMS Pa rt D Defin ed Qualifi ed Facilit y is not u sed for th is Trans C ode
8833	"DATA",900 2313.93,65 5,0)
8834	253^Medica id ID Numb er is not used for t his Transa ction Code
8835	"DATA",900 2313.93,65 6,0)
8836	254^Medica id Agency Number is not used f or this Tr ansaction Code
8837	"DATA",900 2313.93,65 7,0)
8838	255^Associ ated Rx/Se rvice Refe rence Numb er is not used for t his Trans Code
8839	"DATA",900 2313.93,65 8,0)
8840	256^Associ ated Presc ription/Se rvice Date is not us ed for thi s Trans Co de
8841	"DATA",900 2313.93,65 9,0)
8842	257^Proced ure Modifi er Code Co unt is not used for this Trans action Cod e
8843	"DATA",900 2313.93,66 0,0)
8844	258^Proced ure Modifi er Code is not used for this T ransaction Code
8845	"DATA",900 2313.93,66 1,0)
8846	259^Quanti ty Dispens ed is not used for t his Transa ction Code
8847	"DATA",900 2313.93,66 2,0)
8848	260^Fill N umber is n ot used fo r this Tra nsaction C ode
8849	"DATA",900 2313.93,66 3,0)
8850	261^Days S upply is n ot used fo r this Tra nsaction C ode
8851	"DATA",900 2313.93,66 4,0)
8852	262^Compou nd Code is not used for this T ransaction Code
8853	"DATA",900 2313.93,66 5,0)
8854	263^DAW/Pr oduct Sele ction Code is not us ed for thi s Trans Co de
8855	"DATA",900 2313.93,66 6,0)
8856	264^Date P rescriptio n Written is not use d for this Transacti on Code
8857	"DATA",900 2313.93,66 7,0)
8858	265^Number of Refill s Authoriz ed is not used for t his Transa ction Code
8859	"DATA",900 2313.93,66 8,0)
8860	266^Prescr iption Ori gin Code i s not used for this Transactio n Code
8861	"DATA",900 2313.93,66 9,0)
8862	267^Submis sion Clari fication C ode Count is not use d for this Trans Cod e
8863	"DATA",900 2313.93,67 0,0)
8864	268^Submis sion Clari fication C ode is not used for this Trans action Cod e
8865	"DATA",900 2313.93,67 1,0)
8866	269^Quanti ty Prescri bed is not used for this Trans action Cod e
8867	"DATA",900 2313.93,67 2,0)
8868	270^Other Coverage C ode is not used for this Trans action Cod e
8869	"DATA",900 2313.93,67 3,0)
8870	271^Specia l Packagin g Indicato r is not u sed for th is Transac tion Code
8871	"DATA",900 2313.93,67 4,0)
8872	272^Origin ally Presc ribed Prod /Serv ID Q ual not us ed for thi s Trans Co de
8873	"DATA",900 2313.93,67 5,0)
8874	273^Origin ally Presc ribed Prod /Serv Code is not us ed for thi s Trans Co de
8875	"DATA",900 2313.93,67 6,0)
8876	274^Origin ally Presc ribed Quan tity is no t used for this Tran saction Co de
8877	"DATA",900 2313.93,67 7,0)
8878	275^Altern ate ID is not used f or this Tr ansaction Code
8879	"DATA",900 2313.93,67 8,0)
8880	276^Schedu led Prescr iption ID Number is not used f or this Tr ansaction Code
8881	"DATA",900 2313.93,67 9,0)
8882	277^Unit o f Measure is not use d for this Transacti on Code
8883	"DATA",900 2313.93,68 0,0)
8884	278^Level of Service is not us ed for thi s Transact ion Code
8885	"DATA",900 2313.93,68 1,0)
8886	279^Prior Authorizat ion Type C ode is not used for this Trans action Cod e
8887	"DATA",900 2313.93,68 2,0)
8888	280^Prior Authorizat ion ID Sub mitted is not used f or this Tr ansaction Code
8889	"DATA",900 2313.93,68 3,0)
8890	281^Interm ediary Aut horization Type ID i s not used for this Trans Code
8891	"DATA",900 2313.93,68 4,0)
8892	282^Interm ediary Aut horization ID is not used for this Trans action Cod e
8893	"DATA",900 2313.93,68 5,0)
8894	283^Dispen sing Statu s is not u sed for th is Transac tion Code
8895	"DATA",900 2313.93,68 6,0)
8896	284^Quanti ty Intende d to be Di spensed is not used for this T rans Code
8897	"DATA",900 2313.93,68 7,0)
8898	285^Days S upply Inte nded to be Dispensed is not us ed for thi s Trans Co de
8899	"DATA",900 2313.93,68 8,0)
8900	286^Delay Reason Cod e is not u sed for th is Transac tion Code
8901	"DATA",900 2313.93,68 9,0)
8902	287^Transa ction Refe rence Numb er is not used for t his Transa ction Code
8903	"DATA",900 2313.93,69 0,0)
8904	288^Patien t Assignme nt Indicat or is not used for t his Trans Code
8905	"DATA",900 2313.93,69 1,0)
8906	289^Route of Adminis tration is not used for this T ransaction Code
8907	"DATA",900 2313.93,69 2,0)
8908	290^Compou nd Type is not used for this T ransaction Code
8909	"DATA",900 2313.93,69 3,0)
8910	291^Medica id Subroga tion ICN/T CN is not used for t his Transa ction Code
8911	"DATA",900 2313.93,69 4,0)
8912	292^Pharma cy Service Type is n ot used fo r this Tra nsaction C ode
8913	"DATA",900 2313.93,69 5,0)
8914	293^Associ ated Rx/Se rvice Prov ider ID Qu al is not used for t his Trans Code
8915	"DATA",900 2313.93,69 6,0)
8916	294^Associ ated Rx/Se rvice Prov ider ID is not used for this T rans Code
8917	"DATA",900 2313.93,69 7,0)
8918	295^Associ ated Rx/Se rvice Ref Num Qual i s not used for this Trans Code
8919	"DATA",900 2313.93,69 8,0)
8920	296^Associ ated Rx/Se rvice Ref Fill Numbe r is not u sed for th is Trans C ode
8921	"DATA",900 2313.93,69 9,0)
8922	297^Time o f Service is not use d for this Transacti on Code
8923	"DATA",900 2313.93,70 0,0)
8924	298^Sales Transactio n ID is no t used for this Tran saction Co de
8925	"DATA",900 2313.93,70 1,0)
8926	299^Report ed Payment Type is n ot used fo r this Tra nsaction C ode
8927	"DATA",900 2313.93,70 2,0)
8928	300^Provid er ID Qual ifier is n ot used fo r this Tra nsaction C ode
8929	"DATA",900 2313.93,70 3,0)
8930	301^Provid er ID is n ot used fo r this Tra nsaction C ode
8931	"DATA",900 2313.93,70 4,0)
8932	302^Prescr iber ID Qu alifier is not used for this T ransaction Code
8933	"DATA",900 2313.93,70 5,0)
8934	303^Prescr iber ID is not used for this T ransaction Code
8935	"DATA",900 2313.93,70 6,0)
8936	304^Prescr iber ID As soc State/ Prov Addre ss not use d for this Trans Cod e
8937	"DATA",900 2313.93,70 7,0)
8938	305^Prescr iber Last Name is no t used for this Tran saction Co de
8939	"DATA",900 2313.93,70 8,0)
8940	306^Prescr iber Phone Number is not used for this T ransaction Code
8941	"DATA",900 2313.93,70 9,0)
8942	307^Primar y Care Pro vider ID Q ualifier i s not used for this Trans Code
8943	"DATA",900 2313.93,71 0,0)
8944	308^Primar y Care Pro vider ID i s not used for this Transactio n Code
8945	"DATA",900 2313.93,71 1,0)
8946	309^Primar y Care Pro vider Last Name is n ot used fo r this Tra nsaction C ode
8947	"DATA",900 2313.93,71 2,0)
8948	310^Prescr iber First Name is n ot used fo r this Tra nsaction C ode
8949	"DATA",900 2313.93,71 3,0)
8950	311^Prescr iber Stree t Address is not use d for this Transacti on Code
8951	"DATA",900 2313.93,71 4,0)
8952	312^Prescr iber City Address is not used for this T ransaction Code
8953	"DATA",900 2313.93,71 5,0)
8954	313^Prescr iber State /Province Address is not used for this T rans Code
8955	"DATA",900 2313.93,71 6,0)
8956	314^Prescr iber ZIP/P ostal Zone is not us ed for thi s Transact ion Code
8957	"DATA",900 2313.93,71 7,0)
8958	315^Prescr iber Alter nate ID Qu alifier is not used for this T rans Code
8959	"DATA",900 2313.93,71 8,0)
8960	316^Prescr iber Alter nate ID is not used for this T ransaction Code
8961	"DATA",900 2313.93,71 9,0)
8962	317^Prescr iber Alt I D Assoc St ate/Prov A ddress not used for this Trans Cd
8963	"DATA",900 2313.93,72 0,0)
8964	318^Other Payer ID Q ualifier i s not used for this Transactio n Code
8965	"DATA",900 2313.93,72 1,0)
8966	319^Other Payer ID i s not used for this Transactio n Code
8967	"DATA",900 2313.93,72 2,0)
8968	320^Other Payer Date is not us ed for thi s Transact ion Code
8969	"DATA",900 2313.93,72 3,0)
8970	321^Intern al Control Number is not used for this T ransaction Code
8971	"DATA",900 2313.93,72 4,0)
8972	322^Other Payer Amou nt Paid Co unt is not used for this Trans action Cod e
8973	"DATA",900 2313.93,72 5,0)
8974	323^Other Payer Amou nt Paid Qu alifier is not used for this T rans Code
8975	"DATA",900 2313.93,72 6,0)
8976	324^Other Payer Amou nt Paid is not used for this T ransaction Code
8977	"DATA",900 2313.93,72 7,0)
8978	325^Other Payer Reje ct Count i s not used for this Transactio n Code
8979	"DATA",900 2313.93,72 8,0)
8980	326^Other Payer Reje ct Code is not used for this T ransaction Code
8981	"DATA",900 2313.93,72 9,0)
8982	327^Other Payer-Pati ent Resp A mount Coun t is not u sed for th is Trans C ode
8983	"DATA",900 2313.93,73 0,0)
8984	328^Other Payer-Pati ent Resp A mount Qual is not us ed for thi s Trans Co de
8985	"DATA",900 2313.93,73 1,0)
8986	329^Other Payer-Pati ent Resp A mount is n ot used fo r this Tra ns Code
8987	"DATA",900 2313.93,73 2,0)
8988	330^Benefi t Stage Co unt is not used for this Trans action Cod e
8989	"DATA",900 2313.93,73 3,0)
8990	331^Benefi t Stage Qu alifier is not used for this T ransaction Code
8991	"DATA",900 2313.93,73 4,0)
8992	332^Benefi t Stage Am ount is no t used for this Tran saction Co de
8993	"DATA",900 2313.93,73 5,0)
8994	333^Employ er Name is not used for this T ransaction Code
8995	"DATA",900 2313.93,73 6,0)
8996	334^Employ er Street Address is not used for this T ransaction Code
8997	"DATA",900 2313.93,73 7,0)
8998	335^Employ er City Ad dress is n ot used fo r this Tra nsaction C ode
8999	"DATA",900 2313.93,73 8,0)
9000	336^Employ er State/P rovince Ad dress is n ot used fo r this Tra nsaction C ode
9001	"DATA",900 2313.93,73 9,0)
9002	337^Employ er Zip/Pos tal Code i s not used for this Transactio n Code
9003	"DATA",900 2313.93,74 0,0)
9004	338^Employ er Phone N umber is n ot used fo r this Tra nsaction C ode
9005	"DATA",900 2313.93,74 1,0)
9006	339^Employ er Contact Name is n ot used fo r this Tra nsaction C ode
9007	"DATA",900 2313.93,74 2,0)
9008	340^Carrie r ID is no t used for this Tran saction Co de
9009	"DATA",900 2313.93,74 3,0)
9010	341^Claim/ Reference ID is not used for t his Transa ction Code
9011	"DATA",900 2313.93,74 4,0)
9012	342^Billin g Entity T ype Indica tor is not used for this Trans action Cod e
9013	"DATA",900 2313.93,74 5,0)
9014	343^Pay To Qualifier is not us ed for thi s Transact ion Code
9015	"DATA",900 2313.93,74 6,0)
9016	344^Pay To ID is not used for this Trans action Cod e
9017	"DATA",900 2313.93,74 7,0)
9018	345^Pay To Name is n ot used fo r this Tra nsaction C ode
9019	"DATA",900 2313.93,74 8,0)
9020	346^Pay To Street Ad dress is n ot used fo r this Tra nsaction C ode
9021	"DATA",900 2313.93,74 9,0)
9022	347^Pay To City Addr ess is not used for this Trans action Cod e
9023	"DATA",900 2313.93,75 0,0)
9024	348^Pay To State/Pro vince Addr ess is not used for this Trans action Cod e
9025	"DATA",900 2313.93,75 1,0)
9026	349^Pay To ZIP/Posta l Zone is not used f or this Tr ansaction Code
9027	"DATA",900 2313.93,75 2,0)
9028	350^Generi c Equivale nt Product ID Qual i s not used for this Trans Code
9029	"DATA",900 2313.93,75 3,0)
9030	351^Generi c Equivale nt Product ID is not used for this Trans action Cod e
9031	"DATA",900 2313.93,75 4,0)
9032	352^DUR/PP S Code Cou nter is no t used for this Tran saction Co de
9033	"DATA",900 2313.93,75 5,0)
9034	353^Reason for Servi ce Code is not used for this T ransaction Code
9035	"DATA",900 2313.93,75 6,0)
9036	354^Profes sional Ser vice Code is not use d for this Transacti on Code
9037	"DATA",900 2313.93,75 7,0)
9038	355^Result of Servic e Code is not used f or this Tr ansaction Code
9039	"DATA",900 2313.93,75 8,0)
9040	356^DUR/PP S Level of Effort is not used for this T ransaction Code
9041	"DATA",900 2313.93,75 9,0)
9042	357^DUR Co -Agent ID Qualifier is not use d for this Transacti on Code
9043	"DATA",900 2313.93,76 0,0)
9044	358^DUR Co -Agent ID is not use d for this Transacti on Code
9045	"DATA",900 2313.93,76 1,0)
9046	359^Ingred ient Cost Submitted is not use d for this Transacti on Code
9047	"DATA",900 2313.93,76 2,0)
9048	360^Dispen sing Fee S ubmitted i s not used for this Transactio n Code
9049	"DATA",900 2313.93,76 3,0)
9050	361^Profes sional Ser vice Fee S ubmitted i s not used for this Trans Code
9051	"DATA",900 2313.93,76 4,0)
9052	362^Patien t Paid Amo unt Submit ted is not used for this Trans action Cod e
9053	"DATA",900 2313.93,76 5,0)
9054	363^Incent ive Amount Submitted is not us ed for thi s Transact ion Code
9055	"DATA",900 2313.93,76 6,0)
9056	364^Other Amount Cla imed Submi tted Count is not us ed for thi s Trans Co de
9057	"DATA",900 2313.93,76 7,0)
9058	365^Other Amount Cla imed Submi tted Qual is not use d for this Trans Cod e
9059	"DATA",900 2313.93,76 8,0)
9060	366^Other Amount Cla imed Submi tted is no t used for this Tran saction Co de
9061	"DATA",900 2313.93,76 9,0)
9062	367^Flat S ales Tax A mount Subm itted is n ot used fo r this Tra nsaction C ode
9063	"DATA",900 2313.93,77 0,0)
9064	368^Percen tage Sales Tax Amoun t Submitte d is not u sed for th is Trans C ode
9065	"DATA",900 2313.93,77 1,0)
9066	369^Percen tage Sales Tax Rate Submitted is not use d for this Trans Cod e
9067	"DATA",900 2313.93,77 2,0)
9068	370^Percen tage Sales Tax Basis Submitted is not us ed for thi s Trans Co de
9069	"DATA",900 2313.93,77 3,0)
9070	371^Usual and Custom ary Charge is not us ed for thi s Transact ion Code
9071	"DATA",900 2313.93,77 4,0)
9072	372^Gross Amount Due is not us ed for thi s Transact ion Code
9073	"DATA",900 2313.93,77 5,0)
9074	373^Basis of Cost De terminatio n is not u sed for th is Transac tion Code
9075	"DATA",900 2313.93,77 6,0)
9076	374^Medica id Paid Am ount is no t used for this Tran saction Co de
9077	"DATA",900 2313.93,77 7,0)
9078	375^Coupon Value Amo unt is not used for this Trans action Cod e
9079	"DATA",900 2313.93,77 8,0)
9080	376^Compou nd Ingredi ent Drug C ost is not used for this Trans action Cod e
9081	"DATA",900 2313.93,77 9,0)
9082	377^Compou nd Ingredi ent Basis of Cost De term not u sed for th is Trans C ode
9083	"DATA",900 2313.93,78 0,0)
9084	378^Compou nd Ingredi ent Modifi er Code Co unt not us ed for thi s Trans Co de
9085	"DATA",900 2313.93,78 1,0)
9086	379^Compou nd Ingredi ent Modifi er Code is not used for this T rans Code
9087	"DATA",900 2313.93,78 2,0)
9088	380^Author ized Repre sentative First Name is not us ed for thi s Trans Co de
9089	"DATA",900 2313.93,78 3,0)
9090	381^Author ized Rep. Last Name is not use d for this Transacti on Code
9091	"DATA",900 2313.93,78 4,0)
9092	382^Author ized Rep. Street Add ress is no t used for this Tran saction Co de
9093	"DATA",900 2313.93,78 5,0)
9094	383^Author ized Rep. City is no t used for this Tran saction Co de
9095	"DATA",900 2313.93,78 6,0)
9096	384^Author ized Rep. State/Prov ince is no t used for this Tran saction Co de
9097	"DATA",900 2313.93,78 7,0)
9098	385^Author ized Rep. Zip/Postal Code is n ot used fo r this Tra nsaction C ode
9099	"DATA",900 2313.93,78 8,0)
9100	386^Prior Authorizat ion Number - Assigne d is not u sed for th is Trans C ode
9101	"DATA",900 2313.93,78 9,0)
9102	387^Author ization Nu mber is no t used for this Tran saction Co de
9103	"DATA",900 2313.93,79 0,0)
9104	388^Prior Auth Suppo rting Docu mentation is not use d for this Trans Cod e
9105	"DATA",900 2313.93,79 1,0)
9106	389^Diagno sis Code C ount is no t used for this Tran saction Co de
9107	"DATA",900 2313.93,79 2,0)
9108	390^Diagno sis Code Q ualifier i s not used for this Transactio n Code
9109	"DATA",900 2313.93,79 3,0)
9110	391^Diagno sis Code i s not used for this Transactio n Code
9111	"DATA",900 2313.93,79 4,0)
9112	392^Clinic al Informa tion Count er is not used for t his Transa ction Code
9113	"DATA",900 2313.93,79 5,0)
9114	393^Measur ement Date is not us ed for thi s Transact ion Code
9115	"DATA",900 2313.93,79 6,0)
9116	394^Measur ement Time is not us ed for thi s Transact ion Code
9117	"DATA",900 2313.93,79 7,0)
9118	395^Measur ement Dime nsion is n ot used fo r this Tra nsaction C ode
9119	"DATA",900 2313.93,79 8,0)
9120	396^Measur ement Unit is not us ed for thi s Transact ion Code
9121	"DATA",900 2313.93,79 9,0)
9122	397^Measur ement Valu e is not u sed for th is Transac tion Code
9123	"DATA",900 2313.93,80 0,0)
9124	398^Reques t Period B egin Date is not use d for this Transacti on Code
9125	"DATA",900 2313.93,80 1,0)
9126	399^Reques t Period R ecert/Revi sed Date i s not used for this Trans Code
9127	"DATA",900 2313.93,80 2,0)
9128	400^Reques t Status i s not used for this Transactio n Code
9129	"DATA",900 2313.93,80 3,0)
9130	401^Length Of Need Q ualifier i s not used for this Transactio n Code
9131	"DATA",900 2313.93,80 4,0)
9132	402^Length Of Need i s not used for this Transactio n Code
9133	"DATA",900 2313.93,80 5,0)
9134	403^Prescr iber/Suppl ier Date S igned is n ot used fo r this Tra nsaction C ode
9135	"DATA",900 2313.93,80 6,0)
9136	404^Suppor ting Docum entation i s not used for this Transactio n Code
9137	"DATA",900 2313.93,80 7,0)
9138	405^Questi on Number/ Letter Cou nt is not used for t his Transa ction Code
9139	"DATA",900 2313.93,80 8,0)
9140	406^Questi on Number/ Letter is not used f or this Tr ansaction Code
9141	"DATA",900 2313.93,80 9,0)
9142	407^Questi on Percent Response is not use d for this Transacti on Code
9143	"DATA",900 2313.93,81 0,0)
9144	408^Questi on Date Re sponse is not used f or this Tr ansaction Code
9145	"DATA",900 2313.93,81 1,0)
9146	409^Questi on Dollar Amount Res ponse is n ot used fo r this Tra nsaction C ode
9147	"DATA",900 2313.93,81 2,0)
9148	410^Questi on Numeric Response is not use d for this Transacti on Code
9149	"DATA",900 2313.93,81 3,0)
9150	411^Questi on Alphanu meric Resp onse is no t used for this Tran saction Co de
9151	"DATA",900 2313.93,81 4,0)
9152	412^Facili ty ID is n ot used fo r this Tra nsaction C ode
9153	"DATA",900 2313.93,81 5,0)
9154	413^Facili ty Name is not used for this T ransaction Code
9155	"DATA",900 2313.93,81 6,0)
9156	414^Facili ty Street Address is not used for this T ransaction Code
9157	"DATA",900 2313.93,81 7,0)
9158	415^Facili ty City Ad dress is n ot used fo r this Tra nsaction C ode
9159	"DATA",900 2313.93,81 8,0)
9160	416^Facili ty State/P rovince Ad dress is n ot used fo r this Tra nsaction C ode
9161	"DATA",900 2313.93,81 9,0)
9162	417^Facili ty ZIP/Pos tal Zone i s not used for this Transactio n Code
9163	"DATA",900 2313.93,82 0,0)
9164	418^Purcha ser ID Qua lifier is not used f or this Tr ansaction Code
9165	"DATA",900 2313.93,82 1,0)
9166	419^Purcha ser ID is not used f or this Tr ansaction Code
9167	"DATA",900 2313.93,82 2,0)
9168	420^Purcha ser ID Ass ociated St ate Code i s not used for this Trans Code
9169	"DATA",900 2313.93,82 3,0)
9170	421^Purcha ser Date o f Birth is not used for this T ransaction Code
9171	"DATA",900 2313.93,82 4,0)
9172	422^Purcha ser Gender Code is n ot used fo r this Tra nsaction C ode
9173	"DATA",900 2313.93,82 5,0)
9174	423^Purcha ser First Name is no t used for this Tran saction Co de
9175	"DATA",900 2313.93,82 6,0)
9176	424^Purcha ser Last N ame is not used for this Trans action Cod e
9177	"DATA",900 2313.93,82 7,0)
9178	425^Purcha ser Street Address i s not used for this Transactio n Code
9179	"DATA",900 2313.93,82 8,0)
9180	426^Purcha ser City A ddress is not used f or this Tr ansaction Code
9181	"DATA",900 2313.93,82 9,0)
9182	427^Purcha ser State/ Province A ddress is not used f or this Tr ansaction Code
9183	"DATA",900 2313.93,83 0,0)
9184	428^Purcha ser ZIP/Po stal Zone is not use d for this Transacti on Code
9185	"DATA",900 2313.93,83 1,0)
9186	429^Purcha ser Countr y Code is not used f or this Tr ansaction Code
9187	"DATA",900 2313.93,83 2,0)
9188	430^Purcha ser Relati onship Cod e is not u sed for th is Transac tion Code
9189	"DATA",900 2313.93,83 3,0)
9190	431^Releas ed Date is not used for this T ransaction Code
9191	"DATA",900 2313.93,83 4,0)
9192	432^Releas ed Time is not used for this T ransaction Code
9193	"DATA",900 2313.93,83 5,0)
9194	433^Servic e Provider Name is n ot used fo r this Tra nsaction C ode
9195	"DATA",900 2313.93,83 6,0)
9196	434^Servic e Provider Street Ad dress is n ot used fo r this Tra nsaction C ode
9197	"DATA",900 2313.93,83 7,0)
9198	435^Servic e Provider City Addr ess is not used for this Trans action Cod e
9199	"DATA",900 2313.93,83 8,0)
9200	436^Servic e Prov Sta te/Provinc e Address is not use d for this Trans Cod e
9201	"DATA",900 2313.93,83 9,0)
9202	437^Servic e Provider ZIP/Posta l Zone is not used f or this Tr ansaction Code
9203	"DATA",900 2313.93,84 0,0)
9204	438^Seller ID Qualif ier is not used for this Trans action Cod e
9205	"DATA",900 2313.93,84 1,0)
9206	439^Seller ID is not used for this Trans action Cod e
9207	"DATA",900 2313.93,84 2,0)
9208	440^Seller Initials is not use d for this Transacti on Code
9209	"DATA",900 2313.93,84 3,0)
9210	441^Other Amount Cla imed Submi tted Group ing Incorr ect
9211	"DATA",900 2313.93,84 4,0)
9212	442^Other Payer Amou nt Paid Gr ouping Inc orrect
9213	"DATA",900 2313.93,84 5,0)
9214	443^Other Payer-Pati ent Respon sibility A mount Grou ping Incor rect
9215	"DATA",900 2313.93,84 6,0)
9216	444^Benefi t Stage Am ount Group ing Incorr ect
9217	"DATA",900 2313.93,84 7,0)
9218	445^Diagno sis Code G rouping In correct
9219	"DATA",900 2313.93,84 8,0)
9220	446^COB/Ot her Paymen ts Segment Incorrect ly Formatt ed
9221	"DATA",900 2313.93,84 9,0)
9222	447^Additi onal Docum entation S egment Inc orrectly F ormatted
9223	"DATA",900 2313.93,85 0,0)
9224	448^Clinic al Segment Incorrect ly Formatt ed
9225	"DATA",900 2313.93,85 1,0)
9226	449^Patien t Segment Incorrectl y Formatte d
9227	"DATA",900 2313.93,85 2,0)
9228	450^Insura nce Segmen t Incorrec tly Format ted
9229	"DATA",900 2313.93,85 3,0)
9230	451^Transa ction Head er Segment Incorrect ly Formatt ed
9231	"DATA",900 2313.93,85 4,0)
9232	452^Claim Segment In correctly Formatted
9233	"DATA",900 2313.93,85 5,0)
9234	453^Pharma cy Provide r Segment Incorrectl y Formatte d
9235	"DATA",900 2313.93,85 6,0)
9236	454^Prescr iber Segme nt Incorre ctly Forma tted
9237	"DATA",900 2313.93,85 7,0)
9238	455^Worker s' Compens ation Segm ent Incorr ectly Form atted
9239	"DATA",900 2313.93,85 8,0)
9240	456^Pricin g Segment Incorrectl y Formatte d
9241	"DATA",900 2313.93,85 9,0)
9242	457^Coupon Segment I ncorrectly Formatted
9243	"DATA",900 2313.93,86 0,0)
9244	458^Prior Authorizat ion Segmen t Incorrec tly Format ted
9245	"DATA",900 2313.93,86 1,0)
9246	459^Facili ty Segment Incorrect ly Formatt ed
9247	"DATA",900 2313.93,86 2,0)
9248	460^Narrat ive Segmen t Incorrec tly Format ted
9249	"DATA",900 2313.93,86 3,0)
9250	461^Purcha ser Segmen t Incorrec tly Format ted
9251	"DATA",900 2313.93,86 4,0)
9252	462^Servic e Provider Segment I ncorrectly Formatted
9253	"DATA",900 2313.93,86 5,0)
9254	463^Pharma cy not con tracted in Assisted Living Net work
9255	"DATA",900 2313.93,86 6,0)
9256	464^Servic e Provider ID Qualif ier Does N ot Precede Service P rovider ID
9257	"DATA",900 2313.93,86 7,0)
9258	465^Patien t ID Quali fier Does Not Preced e Patient ID
9259	"DATA",900 2313.93,86 8,0)
9260	466^Rx/Ser vice Ref N umber Qual ifier Does Not Prece de Rx/Serv ice Ref Nu mber
9261	"DATA",900 2313.93,86 9,0)
9262	467^Produc t/Service ID Qualifi er Does No t Precede Product/Se rvice ID
9263	"DATA",900 2313.93,87 0,0)
9264	468^Proced ure Modifi er Code Co unt Does N ot Precede Procedure Modifier Code
9265	"DATA",900 2313.93,87 1,0)
9266	469^Submis sion Clari fication C d Cnt Foll ows Submis sion Clari fication C ode
9267	"DATA",900 2313.93,87 2,0)
9268	470^Orig P rscrbd Pro d/Serv ID Qual Follo ws Orig Pr scrbd Prod /Serv Code
9269	"DATA",900 2313.93,87 3,0)
9270	471^Oth Am t Claimed Submitted Cnt Follow s Oth Amt Claimed Am t And/Or Q ual
9271	"DATA",900 2313.93,87 4,0)
9272	472^Other Amt Claime d Submitte d Qual Fol lows Other Amt Claim ed Submitt ed
9273	"DATA",900 2313.93,87 5,0)
9274	473^Provid er Id Qual ifier Does Not Prece de Provide r ID
9275	"DATA",900 2313.93,87 6,0)
9276	474^Prescr iber Id Qu alifier Do es Not Pre cede Presc riber ID
9277	"DATA",900 2313.93,87 7,0)
9278	475^Primar y Care Pro v ID Qual Does Not P recede Pri mary Care Provider I D
9279	"DATA",900 2313.93,87 8,0)
9280	476^COB/Ot her Paymen ts Count D oes Not Pr ecede Othe r Payer Co verage Typ e
9281	"DATA",900 2313.93,87 9,0)
9282	477^Other Payer ID C ount Does Not Preced e Other Pa yer ID Dat a Fields
9283	"DATA",900 2313.93,88 0,0)
9284	478^Other Payer ID Q ualifier D oes Not Pr ecede Othe r Payer ID
9285	"DATA",900 2313.93,88 1,0)
9286	479^Other Payer Amt Paid Count Follows O ther Payer Amt Paid And/Or Qua l
9287	"DATA",900 2313.93,88 2,0)
9288	480^Other Payer Amou nt Paid Qu al Does No t Precede Other Paye r Amount P aid
9289	"DATA",900 2313.93,88 3,0)
9290	481^Other Payer Reje ct Count D oes Not Pr ecede Othe r Payer Re ject Code
9291	"DATA",900 2313.93,88 4,0)
9292	482^Oth Pa yer-Pat Re sp Amt Cnt Follows O th Payer-P at Resp Am t and/or Q ual
9293	"DATA",900 2313.93,88 5,0)
9294	483^Other Payer-Pati ent Resp A mt Qual Fo llows Othe r Payer-Pa tient Resp Amt
9295	"DATA",900 2313.93,88 6,0)
9296	484^Benefi t Stage Co unt Does N ot Precede Benefit S tage Amoun t and/or Q ual
9297	"DATA",900 2313.93,88 7,0)
9298	485^Benefi t Stage Qu alifier Do es Not Pre cede Benef it Stage A mount
9299	"DATA",900 2313.93,88 8,0)
9300	486^Pay To Qualifier Does Not Precede Pa y To ID
9301	"DATA",900 2313.93,88 9,0)
9302	487^Generi c Equivale nt Prod Id Qual Foll ows Generi c Equivale nt Prod Id
9303	"DATA",900 2313.93,89 0,0)
9304	488^DUR/PP S Code Cou nter Does Not Preced e DUR Data Fields
9305	"DATA",900 2313.93,89 1,0)
9306	489^DUR Co -Agent ID Qualifier Does Not P recede DUR Co-Agent ID
9307	"DATA",900 2313.93,89 2,0)
9308	490^Compou nd Ingredi ent Compon ent Cnt Fo llows Comp ound Prod ID And/Or Qual
9309	"DATA",900 2313.93,89 3,0)
9310	491^Compou nd Product ID Qualif ier Does N ot Precede Compound Product ID
9311	"DATA",900 2313.93,89 4,0)
9312	492^Compou nd Ingredi ent Mod Co de Cnt Fol lows Compo und Ingred ient Mod C ode
9313	"DATA",900 2313.93,89 5,0)
9314	493^Diagno sis Code C ount Does Not Preced e Diagnosi s Code And /Or Qualif ier
9315	"DATA",900 2313.93,89 6,0)
9316	494^Diagno sis Code Q ualifier D oes Not Pr ecede Diag nosis Code
9317	"DATA",900 2313.93,89 7,0)
9318	495^Clinic al Info Co unter Does Not Prece de Clinica l Measurem ent data
9319	"DATA",900 2313.93,89 8,0)
9320	496^Length Of Need Q ualifier D oes Not Pr ecede Leng th Of Need
9321	"DATA",900 2313.93,89 9,0)
9322	497^Questi on Number/ Letter Cou nt Does No t Precede Question N umber/Lett er
9323	"DATA",900 2313.93,90 0,0)
9324	498^Accumu lator Mont h Count Do es Not Pre cede Accum ulator Mon th
9325	"DATA",900 2313.93,90 1,0)
9326	499^Addres s Count Do es Not Pre cede Addre ss Data Fi elds
9327	"DATA",900 2313.93,90 2,0)
9328	500^Patien t ID Quali fier Count Does Not Precede Pa tient ID D ata Fields
9329	"DATA",900 2313.93,90 3,0)
9330	501^Prescr iber ID Co unt Does N ot Precede Prescribe r ID Data Fields
9331	"DATA",900 2313.93,90 4,0)
9332	502^Prescr iber Speci alty Count Does Not Precede Pr escriber S pecialty
9333	"DATA",900 2313.93,90 5,0)
9334	503^Teleph one Number Count Doe s Not Prec ede Teleph one Number Data Fiel ds
9335	"DATA",900 2313.93,90 6,0)
9336	504^Benefi t Stage Qu alifier Va lue Not Su pported
9337	"DATA",900 2313.93,90 7,0)
9338	505^Other Payer Cove rage Type Value Not Supported
9339	"DATA",900 2313.93,90 8,0)
9340	506^Prescr iption/Ser vice Refer ence Numbe r Qualifie r Value No t Supporte d
9341	"DATA",900 2313.93,90 9,0)
9342	507^Additi onal Docum entation T ype ID Val ue Not Sup ported
9343	"DATA",900 2313.93,91 0,0)
9344	508^Author ized Repre sentative State/Prov ince Addre ss Value N ot Support ed
9345	"DATA",900 2313.93,91 1,0)
9346	509^Basis Of Request Value Not Supported
9347	"DATA",900 2313.93,91 2,0)
9348	510^Billin g Entity T ype Indica tor Value Not Suppor ted
9349	"DATA",900 2313.93,91 3,0)
9350	511^CMS Pa rt D Defin ed Qualifi ed Facilit y Value No t Supporte d
9351	"DATA",900 2313.93,91 4,0)
9352	512^Compou nd Code Va lue Not Su pported
9353	"DATA",900 2313.93,91 5,0)
9354	513^Compou nd Dispens ing Unit F orm Indica tor Value Not Suppor ted
9355	"DATA",900 2313.93,91 6,0)
9356	514^Compou nd Ingredi ent Basis of Cost De terminatio n Value No t Supporte d
9357	"DATA",900 2313.93,91 7,0)
9358	515^Compou nd Product ID Qualif ier Value Not Suppor ted
9359	"DATA",900 2313.93,91 8,0)
9360	516^Compou nd Type Va lue Not Su pported
9361	"DATA",900 2313.93,91 9,0)
9362	517^Coupon Type Valu e Not Supp orted
9363	"DATA",900 2313.93,92 0,0)
9364	518^DUR Co -Agent ID Qualifier Value Not Supported
9365	"DATA",900 2313.93,92 1,0)
9366	519^DUR/PP S Level Of Effort Va lue Not Su pported
9367	"DATA",900 2313.93,92 2,0)
9368	520^Delay Reason Cod e Value No t Supporte d
9369	"DATA",900 2313.93,92 3,0)
9370	521^Diagno sis Code Q ualifier V alue Not S upported
9371	"DATA",900 2313.93,92 4,0)
9372	522^Dispen sing Statu s Value No t Supporte d
9373	"DATA",900 2313.93,92 5,0)
9374	523^Eligib ility Clar ification Code Value Not Suppo rted
9375	"DATA",900 2313.93,92 6,0)
9376	524^Employ er State/P rovince Ad dress Valu e Not Supp orted
9377	"DATA",900 2313.93,92 7,0)
9378	525^Facili ty State/P rovince Ad dress Valu e Not Supp orted
9379	"DATA",900 2313.93,92 8,0)
9380	526^Header Response Status Val ue Not Sup ported
9381	"DATA",900 2313.93,92 9,0)
9382	527^Interm ediary Aut horization Type ID V alue Not S upported
9383	"DATA",900 2313.93,93 0,0)
9384	528^Length of Need Q ualifier V alue Not S upported
9385	"DATA",900 2313.93,93 1,0)
9386	529^Level Of Service Value Not Supported
9387	"DATA",900 2313.93,93 2,0)
9388	530^Measur ement Dime nsion Valu e Not Supp orted
9389	"DATA",900 2313.93,93 3,0)
9390	531^Measur ement Unit Value Not Supported
9391	"DATA",900 2313.93,93 4,0)
9392	532^Medica id Indicat or Value N ot Support ed
9393	"DATA",900 2313.93,93 5,0)
9394	533^Origin ally Presc ribed Prod uct/Servic e ID Quali fier Value Not Suppo rted
9395	"DATA",900 2313.93,93 6,0)
9396	534^Other Amount Cla imed Submi tted Quali fier Value Not Suppo rted
9397	"DATA",900 2313.93,93 7,0)
9398	535^Other Coverage C ode Value Not Suppor ted
9399	"DATA",900 2313.93,93 8,0)
9400	536^Other Payer-Pati ent Respon sibility A mount Qual Value Not Supported
9401	"DATA",900 2313.93,93 9,0)
9402	537^Patien t Assignme nt Indicat or Value N ot Support ed
9403	"DATA",900 2313.93,94 0,0)
9404	538^Patien t Gender C ode Value Not Suppor ted
9405	"DATA",900 2313.93,94 1,0)
9406	539^Patien t State/Pr ovince Add ress Value Not Suppo rted
9407	"DATA",900 2313.93,94 2,0)
9408	540^Pay to State/Pro vince Addr ess Value Not Suppor ted
9409	"DATA",900 2313.93,94 3,0)
9410	541^Percen tage Sales Tax Basis Submitted Value Not Supported
9411	"DATA",900 2313.93,94 4,0)
9412	542^Pregna ncy Indica tor Value Not Suppor ted
9413	"DATA",900 2313.93,94 5,0)
9414	543^Prescr iber ID Qu alifier Va lue Not Su pported
9415	"DATA",900 2313.93,94 6,0)
9416	544^Prescr iber State /Province Address Va lue Not Su pported
9417	"DATA",900 2313.93,94 7,0)
9418	545^Prescr iption Ori gin Code V alue Not S upported
9419	"DATA",900 2313.93,94 8,0)
9420	546^Primar y Care Pro vider ID Q ualifier V alue Not S upported
9421	"DATA",900 2313.93,94 9,0)
9422	547^Prior Authorizat ion Type C ode Value Not Suppor ted
9423	"DATA",900 2313.93,95 0,0)
9424	548^Provid er Accept Assignment Indicator Value Not Supported
9425	"DATA",900 2313.93,95 1,0)
9426	549^Provid er ID Qual ifier Valu e Not Supp orted
9427	"DATA",900 2313.93,95 2,0)
9428	550^Reques t Status V alue Not S upported
9429	"DATA",900 2313.93,95 3,0)
9430	551^Reques t Type Val ue Not Sup ported
9431	"DATA",900 2313.93,95 4,0)
9432	552^Route of Adminis tration Va lue Not Su pported
9433	"DATA",900 2313.93,95 5,0)
9434	553^Smoker /Non-Smoke r Code Val ue Not Sup ported
9435	"DATA",900 2313.93,95 6,0)
9436	554^Specia l Packagin g Indicato r Value No t Supporte d
9437	"DATA",900 2313.93,95 7,0)
9438	555^Transa ction Coun t Value No t Supporte d
9439	"DATA",900 2313.93,95 8,0)
9440	556^Unit O f Measure Value Not Supported
9441	"DATA",900 2313.93,95 9,0)
9442	557^COB Se gment Pres ent On A N on-COB Cla im
9443	"DATA",900 2313.93,96 0,0)
9444	7F^Future date not a llowed for Date of B irth
9445	"DATA",900 2313.93,96 1,0)
9446	A1^ID Subm itted is a ssociated with a San ctioned Pr escriber
9447	"DATA",900 2313.93,96 2,0)
9448	A2^ID Subm itted is a ssociated to a Decea sed Prescr iber
9449	"DATA",900 2313.93,96 3,0)
9450	TF^M/I Tec hnician In itials
9451	"DATA",900 2313.93,96 4,0)
9452	X0^M/I Ass ociated Pr escription /Service F ill Number
9453	"DATA",900 2313.93,96 5,0)
9454	XZ^M/I Ass ociated Pr escription /Service R eference N umber Qual ifier
9455	"DATA",900 2313.93,96 6,0)
9456	Y0^M/I Pur chaser Las t Name
9457	"DATA",900 2313.93,96 7,0)
9458	Y1^M/I Pur chaser Str eet Addres s
9459	"DATA",900 2313.93,96 8,0)
9460	Y2^M/I Pur chaser Cit y Address
9461	"DATA",900 2313.93,96 9,0)
9462	Y3^M/I Pur chaser Sta te/Provinc e Code
9463	"DATA",900 2313.93,97 0,0)
9464	Y4^M/I Pur chaser Zip /Postal Co de
9465	"DATA",900 2313.93,97 1,0)
9466	Y5^M/I Pur chaser Cou ntry Code
9467	"DATA",900 2313.93,97 2,0)
9468	Y6^M/I Tim e of Servi ce
9469	"DATA",900 2313.93,97 3,0)
9470	Y7^M/I Ass ociated Pr escription /Service P rovider ID Qualifier
9471	"DATA",900 2313.93,97 4,0)
9472	Y8^M/I Ass ociated Pr escription /Service P rovider ID
9473	"DATA",900 2313.93,97 5,0)
9474	Y9^M/I Sel ler ID
9475	"DATA",900 2313.93,97 6,0)
9476	YK^M/I Ser vice Provi der Name
9477	"DATA",900 2313.93,97 7,0)
9478	YM^M/I Ser vice Provi der Street Address
9479	"DATA",900 2313.93,97 8,0)
9480	YN^M/I Ser vice Provi der City A ddress
9481	"DATA",900 2313.93,97 9,0)
9482	YP^M/I Ser vice Provi der State/ Province C ode Addres s
9483	"DATA",900 2313.93,98 0,0)
9484	YQ^M/I Ser vice Provi der Zip/Po stal Code
9485	"DATA",900 2313.93,98 1,0)
9486	YR^M/I Pat ient ID As sociated S tate/Provi nce Addres s
9487	"DATA",900 2313.93,98 2,0)
9488	YS^M/I Pur chaser Rel ationship Code
9489	"DATA",900 2313.93,98 3,0)
9490	YT^M/I Sel ler Initia ls
9491	"DATA",900 2313.93,98 4,0)
9492	YU^M/I Pur chaser ID Qualifier
9493	"DATA",900 2313.93,98 5,0)
9494	YV^M/I Pur chaser ID
9495	"DATA",900 2313.93,98 6,0)
9496	YW^M/I Pur chaser ID Associated State/Pro vince Code
9497	"DATA",900 2313.93,98 7,0)
9498	YX^M/I Pur chaser Dat e of Birth
9499	"DATA",900 2313.93,98 8,0)
9500	YY^M/I Pur chaser Gen der Code
9501	"DATA",900 2313.93,98 9,0)
9502	YZ^M/I Pur chaser Fir st Name
9503	"DATA",900 2313.93,99 0,0)
9504	Z0^Purchas er Country Code Valu e Not Supp orted For Processor/ Payer
9505	"DATA",900 2313.93,99 1,0)
9506	Z1^Prescri ber Altern ate ID Qua lifier Val ue Not Sup ported
9507	"DATA",900 2313.93,99 2,0)
9508	Z2^M/I Pur chaser Seg ment
9509	"DATA",900 2313.93,99 3,0)
9510	Z3^Purchas er Segment Present O n A Non-Co ntrolled S ub Reporti ng Trans
9511	"DATA",900 2313.93,99 4,0)
9512	Z4^Purchas er Segment Required On A Contr olled Subs tance Repo rting Tran s
9513	"DATA",900 2313.93,99 5,0)
9514	Z5^M/I Ser vice Provi der Segmen t
9515	"DATA",900 2313.93,99 6,0)
9516	Z6^Service Prov Segm ent Presen t On A non -Controlle d Sub Repo rting Tran s
9517	"DATA",900 2313.93,99 7,0)
9518	Z7^Service Provider Segment Re quired On A Controll ed Sub Rep orting Tra ns
9519	"DATA",900 2313.93,99 8,0)
9520	Z8^Purchas er Relatio nship Code Value Not Supported
9521	"DATA",900 2313.93,99 9,0)
9522	Z9^Prescri ber Altern ate ID Not Covered
9523	"DATA",900 2313.93,10 00,0)
9524	ZB^M/I Sel ler ID Qua lifier
9525	"DATA",900 2313.93,10 01,0)
9526	ZC^Assoc R x/Service Prov ID Qu al Value N ot Support ed For Pro cessor/Pay er
9527	"DATA",900 2313.93,10 02,0)
9528	ZD^Associa ted Rx/Ser vice Refer ence Numbe r Qualifie r Value No t Supporte d
9529	"DATA",900 2313.93,10 03,0)
9530	ZF^M/I Sal es Transac tion ID
9531	"DATA",900 2313.93,10 04,0)
9532	ZK^M/I Pre scriber ID Associate d State/Pr ovince Add ress
9533	"DATA",900 2313.93,10 05,0)
9534	ZM^M/I Pre scriber Al ternate ID Qualifier
9535	"DATA",900 2313.93,10 06,0)
9536	ZN^Purchas er ID Qual ifier Valu e Not Supp orted For Processor/ Payer
9537	"DATA",900 2313.93,10 07,0)
9538	ZP^M/I Pre scriber Al ternate ID
9539	"DATA",900 2313.93,10 08,0)
9540	ZQ^M/I Pre scriber Al ternate ID Associate d State/Pr ovince Add ress
9541	"DATA",900 2313.93,10 09,0)
9542	ZS^M/I Rep orted Paym ent Type
9543	"DATA",900 2313.93,10 10,0)
9544	ZT^M/I Rel eased Date
9545	"DATA",900 2313.93,10 11,0)
9546	ZU^M/I Rel eased Time
9547	"DATA",900 2313.93,10 12,0)
9548	ZV^Reporte d Payment Type Value Not Suppo rted
9549	"DATA",900 2313.93,10 13,0)
9550	ZW^M/I Com pound Prep aration Ti me
9551	"DATA",900 2313.93,10 14,0)
9552	ZX^M/I CMS Part D Co ntract ID
9553	"DATA",900 2313.93,10 15,0)
9554	ZY^M/I Med icare Part D Plan Be nefit Pack age (PBP)
9555	"DATA",900 2313.93,10 16,0)
9556	ZZ^Cardhol der ID sub mitted is inactive. New Cardho lder ID on file
9557	"DATA",900 2313.93,10 17,0)
9558	eC^CHAMPVA -DRUG NON BILLABLE
9559	"DATA",900 2313.93,10 18,0)
9560	569^Provid e Notice: Medicare P rescriptio n Drug Cov erage and Your Right s
9561	"DATA",900 2313.93,10 19,0)
9562	597^LTC Di spensing T ype Does N ot Support The Packa ging Type
9563	"DATA",900 2313.93,10 20,0)
9564	709^M/I Re cord Type
9565	"DATA",900 2313.93,10 21,0)
9566	558^Part D Plan cann ot coordin ate benefi ts with an other Part D Plan
9567	"DATA",900 2313.93,10 22,0)
9568	559^ID Sub mitted is associated with a Sa nctioned P harmacy
9569	"DATA",900 2313.93,10 23,0)
9570	560^Pharma cy Not Con tracted in Retail Ne twork
9571	"DATA",900 2313.93,10 24,0)
9572	561^Pharma cy Not Con tracted in Mail Orde r Network
9573	"DATA",900 2313.93,10 25,0)
9574	562^Pharma cy Not Con tracted in Hospice N etwork
9575	"DATA",900 2313.93,10 26,0)
9576	563^Pharma cy Not Con tracted in Veterans Administra tion Netwo rk
9577	"DATA",900 2313.93,10 27,0)
9578	564^Pharma cy Not Con tracted in Military Network
9579	"DATA",900 2313.93,10 28,0)
9580	565^Patien t Country Code Value Not Suppo rted
9581	"DATA",900 2313.93,10 29,0)
9582	566^Patien t Country Code Not U sed For Th is Transac tion
9583	"DATA",900 2313.93,10 30,0)
9584	567^M/I Ve terinary U se Indicat or
9585	"DATA",900 2313.93,10 31,0)
9586	568^Veteri nary Use I ndicator V alue Not S upported
9587	"DATA",900 2313.93,10 32,0)
9588	570^Veteri nary Use I ndicator N ot Used Fo r This Tra nsaction
9589	"DATA",900 2313.93,10 33,0)
9590	571^Patien t ID Assoc iated Stat e/Province Address V alue Not S upported
9591	"DATA",900 2313.93,10 34,0)
9592	572^Mediga p ID Not C overed
9593	"DATA",900 2313.93,10 35,0)
9594	573^Prescr iber Alt I D Assoc St ate/Provin ce Address Value Not Supported
9595	"DATA",900 2313.93,10 36,0)
9596	574^Compou nd Ingredi ent Modifi er Code No t Covered
9597	"DATA",900 2313.93,10 37,0)
9598	575^Purcha ser State/ Province A ddress Val ue Not Sup ported
9599	"DATA",900 2313.93,10 38,0)
9600	576^Servic e Provider State/Pro vince Addr ess Value Not Suppor ted
9601	"DATA",900 2313.93,10 39,0)
9602	577^M/I Ot her Payer ID
9603	"DATA",900 2313.93,10 40,0)
9604	578^Other Payer ID C ount Does Not Match Number of Repetition s
9605	"DATA",900 2313.93,10 41,0)
9606	579^Other Payer ID C ount Excee ds Number Of Occurre nces Suppo rted
9607	"DATA",900 2313.93,10 42,0)
9608	580^Other Payer ID C ount Group ing Incorr ect
9609	"DATA",900 2313.93,10 43,0)
9610	581^Other Payer ID C ount is no t used for this Tran saction Co de
9611	"DATA",900 2313.93,10 44,0)
9612	582^M/I Fi ll Number
9613	"DATA",900 2313.93,10 45,0)
9614	583^Provid er ID Not Covered
9615	"DATA",900 2313.93,10 46,0)
9616	584^Purcha ser ID Ass ociated St ate/Provin ce Code Va lue Not Su pported
9617	"DATA",900 2313.93,10 47,0)
9618	585^Fill N umber Valu e Not Supp orted
9619	"DATA",900 2313.93,10 48,0)
9620	586^Facili ty ID Not Covered
9621	"DATA",900 2313.93,10 49,0)
9622	587^Carrie r ID Not C overed
9623	"DATA",900 2313.93,10 50,0)
9624	588^Altern ate ID Not Covered
9625	"DATA",900 2313.93,10 51,0)
9626	589^Patien t ID Not C overed
9627	"DATA",900 2313.93,10 52,0)
9628	590^Compou nd Dosage Form Not C overed
9629	"DATA",900 2313.93,10 53,0)
9630	591^Plan I D Not Cove red
9631	"DATA",900 2313.93,10 54,0)
9632	592^DUR Co -Agent ID Not Covere d
9633	"DATA",900 2313.93,10 55,0)
9634	593^M/I Da te of Serv ice
9635	"DATA",900 2313.93,10 56,0)
9636	594^Pay To ID Not Co vered
9637	"DATA",900 2313.93,10 57,0)
9638	595^Associ ated Presc ription/Se rvice Prov ider ID No t Covered
9639	"DATA",900 2313.93,10 58,0)
9640	596^Compou nd Prepara tion Time Not Used F or This Tr ansaction Code
9641	"DATA",900 2313.93,10 59,0)
9642	598^More T han One Pa tient Foun d
9643	"DATA",900 2313.93,10 60,0)
9644	599^Cardho lder ID Ma tched But Last Name Did Not
9645	"DATA",900 2313.93,10 61,0)
9646	600^Covera ge Outside Submitted Date Of S ervice
9647	"DATA",900 2313.93,10 62,0)
9648	601^Interm ediary Aut h Type ID Does Not P recede Int ermediary Auth ID
9649	"DATA",900 2313.93,10 63,0)
9650	602^Assoc Rx/Serv Pr ov ID Qual Does Not Precede As soc Rx/Ser vice Prov ID
9651	"DATA",900 2313.93,10 64,0)
9652	603^Prescr iber Alter nate ID Qu al Does No t Precede Prescriber Alternate ID
9653	"DATA",900 2313.93,10 65,0)
9654	604^Purcha ser ID Qua lifier Doe s Not Prec ede Purcha ser ID
9655	"DATA",900 2313.93,10 66,0)
9656	605^Seller ID Qualif ier Does N ot Precede Seller ID
9657	"DATA",900 2313.93,10 67,0)
9658	606^Brand Drug/Speci fic Labele r Code Req uired
9659	"DATA",900 2313.93,10 68,0)
9660	607^Info R eporting ( N1/N3) Tra ns Cannot Be Matched To A Clai m (B1/B3)
9661	"DATA",900 2313.93,10 69,0)
9662	608^Step T herapy/Alt Drug Ther apy Req'd Prior To S ubmitted P rod Serv I D
9663	"DATA",900 2313.93,10 70,0)
9664	609^COB Cl aim Not Re quired, Pa tient Liab ility Amou nt Submitt ed Was Zer o
9665	"DATA",900 2313.93,10 71,0)
9666	610^Info R eporting T rans Match ed to Reve rsed/Rejec ted Claim Under Part D
9667	"DATA",900 2313.93,10 72,0)
9668	611^Supp C laim Was M atched To A Claim Co vered By A Benefit O th Than Pa rt D
9669	"DATA",900 2313.93,10 73,0)
9670	612^LTC Ap propriate Dispensing Invalid S ubmission Clarificat ion Code C ombo
9671	"DATA",900 2313.93,10 74,0)
9672	613^Packag ing Method ology Or D ispensing Frequency M/I For LT C Short Cy cle
9673	"DATA",900 2313.93,10 75,0)
9674	614^Upperc ase Charac ter(s) Req uired
9675	"DATA",900 2313.93,10 76,0)
9676	615^Basis Of Cost De term Value 14 Req'd When Compo und Ing Qt y 0, Cost> $0
9677	"DATA",900 2313.93,10 77,0)
9678	616^Submis sion Clari fication C ode 8 Req' d When Com pound Ingr edient Qty 0
9679	"DATA",900 2313.93,10 78,0)
9680	617^Compou nd Ingredi ent Drug C ost Cannot Be Negati ve Amount
9681	"DATA",900 2313.93,10 79,0)
9682	618^Submit ted Prescr iber's DEA Does Not Allow This Drug DEA Schedule
9683	"DATA",900 2313.93,10 80,0)
9684	619^Prescr iber Type 1 NPI Requ ired
9685	"DATA",900 2313.93,10 81,0)
9686	620^This P roduct/Ser vice May B e Covered Under Medi care Part D
9687	"DATA",900 2313.93,10 82,0)
9688	621^This M edicaid Pa tient Is M edicare El igible
9689	"DATA",900 2313.93,10 83,0)
9690	645^Repack aged produ ct is not covered by the contr act
9691	"DATA",900 2313.93,10 84,0)
9692	646^Pat No t Eligible Due To No n Payment Of Premium . Pat To C ontact Pla n
9693	"DATA",900 2313.93,10 85,0)
9694	647^Quanti ty Prescri bed Requir ed For CII Prescript ion
9695	"DATA",900 2313.93,10 86,0)
9696	648^Qty Pr escribed D oesn't Mat ch Qty Pre scribed On Original CII Dispen sing
9697	"DATA",900 2313.93,10 87,0)
9698	649^Cumula tive Quant ity For Th is CII Rx Number Exc eeds Quant ity Prescr ibed
9699	"DATA",900 2313.93,10 88,0)
9700	650^Fill D ate Greate r Than 60 Days From CII Date R x Written (414-DE)
9701	"DATA",900 2313.93,10 89,0)
9702	1K^M/I Pat ient Count ry Code
9703	"DATA",900 2313.93,10 90,0)
9704	622^COB Cl aim not re quired, pa tient liab ility amou nt submitt ed was zer o
9705	"DATA",900 2313.93,10 91,0)
9706	623^M/I Au thorized R epresentat ive Countr y Code
9707	"DATA",900 2313.93,10 92,0)
9708	624^M/I Em ployer Cou ntry Code
9709	"DATA",900 2313.93,10 93,0)
9710	625^M/I En tity Count ry Code
9711	"DATA",900 2313.93,10 94,0)
9712	627^M/I Fa cility Cou ntry Code
9713	"DATA",900 2313.93,10 95,0)
9714	628^M/I Pa tient ID A ssociated Country Co de
9715	"DATA",900 2313.93,10 96,0)
9716	629^M/I Pa y to Count ry Code
9717	"DATA",900 2313.93,10 97,0)
9718	630^M/I Pr escriber A lternate I D Associat ed Country Code
9719	"DATA",900 2313.93,10 98,0)
9720	631^M/I Pr escriber I D Associat ed Country Code
9721	"DATA",900 2313.93,10 99,0)
9722	632^M/I Pr escriber C ountry Cod e
9723	"DATA",900 2313.93,11 00,0)
9724	633^M/I Pu rchaser ID Associate d Country Code
9725	"DATA",900 2313.93,11 01,0)
9726	634^Author ized Repre sentative Country Co de Value N ot Support ed
9727	"DATA",900 2313.93,11 02,0)
9728	635^Employ er Country Code Valu e Not Supp orted
9729	"DATA",900 2313.93,11 03,0)
9730	637^Entity Country C ode Value Not Suppor ted
9731	"DATA",900 2313.93,11 04,0)
9732	638^Facili ty Country Code Valu e Not Supp orted
9733	"DATA",900 2313.93,11 05,0)
9734	639^Patien t ID Assoc iated Coun try Code V alue Not S upported
9735	"DATA",900 2313.93,11 06,0)
9736	640^Pay to Country C ode Value Not Suppor ted
9737	"DATA",900 2313.93,11 07,0)
9738	641^M/I Pr escriber A lt ID Asso ciated Cou ntry Code Value Not Supported
9739	"DATA",900 2313.93,11 08,0)
9740	642^M/I Pr escriber I D Associat ed Country Code Valu e Not Supp orted
9741	"DATA",900 2313.93,11 09,0)
9742	643^M/I Pr escriber C ountry Cod e Value No t Supporte d
9743	"DATA",900 2313.93,11 10,0)
9744	644^M/I Pu rchaser ID Associate d Country Code Value Not Suppo rted
9745	"DATA",900 2313.93,11 11,0)
9746	651^REMS: Mandatory data eleme nt(s) miss ing
9747	"DATA",900 2313.93,11 12,0)
9748	652^REMS: Prescriber not match ed or may not be enr olled
9749	"DATA",900 2313.93,11 13,0)
9750	653^REMS: Patient no t matched or may not be enroll ed
9751	"DATA",900 2313.93,11 14,0)
9752	654^REMS: Pharmacy n ot matched or may no t be enrol led
9753	"DATA",900 2313.93,11 15,0)
9754	655^REMS: Multiple p atient mat ches
9755	"DATA",900 2313.93,11 16,0)
9756	656^REMS: Patient ag e not matc hed
9757	"DATA",900 2313.93,11 17,0)
9758	657^REMS: Patient ge nder not m atched
9759	"DATA",900 2313.93,11 18,0)
9760	658^REMS: Pharmacy h as not enr olled
9761	"DATA",900 2313.93,11 19,0)
9762	659^REMS: Pharmacy h as not ren ewed enrol lment
9763	"DATA",900 2313.93,11 20,0)
9764	660^REMS: Pharmacy h as not sub mitted agr eement for m
9765	"DATA",900 2313.93,11 21,0)
9766	661^REMS: Pharmacy h as been su spended du e to non-c ompliance
9767	"DATA",900 2313.93,11 22,0)
9768	662^REMS: Prescriber has not e nrolled
9769	"DATA",900 2313.93,11 23,0)
9770	663^REMS: Prescriber has not c ompleted a knowledge assessmen t
9771	"DATA",900 2313.93,11 24,0)
9772	664^REMS: Prescriber has been suspended due to non -complianc e
9773	"DATA",900 2313.93,11 25,0)
9774	665^REMS: Excessive days suppl y
9775	"DATA",900 2313.93,11 26,0)
9776	666^REMS: Insufficie nt days su pply
9777	"DATA",900 2313.93,11 27,0)
9778	667^REMS: Excessive dosage
9779	"DATA",900 2313.93,11 28,0)
9780	668^REMS: Insufficie nt dosage
9781	"DATA",900 2313.93,11 29,0)
9782	669^REMS: Refills no t permitte d
9783	"DATA",900 2313.93,11 30,0)
9784	670^REMS: Laboratory test resu lts not do cumented
9785	"DATA",900 2313.93,11 31,0)
9786	671^REMS: Laboratory test not conducted within spe cified tim e period
9787	"DATA",900 2313.93,11 32,0)
9788	672^REMS: Dispensing not autho rized due to laborat ory test r esults
9789	"DATA",900 2313.93,11 33,0)
9790	673^REMS: Prescriber counselin g of patie nt not doc umented
9791	"DATA",900 2313.93,11 34,0)
9792	674^REMS: Prescriber has not d ocumented safe use c onditions
9793	"DATA",900 2313.93,11 35,0)
9794	675^REMS: Prescriber has not d ocumented patient op ioid toler ance
9795	"DATA",900 2313.93,11 36,0)
9796	676^REMS: Prescriber has not d ocumented patient co ntraceptiv e use
9797	"DATA",900 2313.93,11 37,0)
9798	677^REMS: Lack of co ntraindica ted therap y not docu mented
9799	"DATA",900 2313.93,11 38,0)
9800	678^REMS: Step thera py not doc umented
9801	"DATA",900 2313.93,11 39,0)
9802	679^REMS: Prescriber has not e nrolled pa tient
9803	"DATA",900 2313.93,11 40,0)
9804	680^REMS: Prescriber must rene w patient enrollment
9805	"DATA",900 2313.93,11 41,0)
9806	681^REMS: Patient en rollment r equirement s have not been met
9807	"DATA",900 2313.93,11 42,0)
9808	682^REMS: Prescriber has not s ubmitted p atient agr eement
9809	"DATA",900 2313.93,11 43,0)
9810	683^REMS: Prescriber has not v erified pa tient's re productive potential
9811	"DATA",900 2313.93,11 44,0)
9812	684^REMS: Patient ha s not docu mented saf e use cond itions
9813	"DATA",900 2313.93,11 45,0)
9814	685^REMS: Patient ha s not docu mented com pleted edu cation
9815	"DATA",900 2313.93,11 46,0)
9816	686^REMS: Patient ha s not docu mented con traceptive use
9817	"DATA",900 2313.93,11 47,0)
9818	687^REMS A dministrat or Denied
9819	"DATA",900 2313.93,11 48,0)
9820	688^REMS: Service Bi lling Deni ed
9821	"DATA",900 2313.93,11 49,0)
9822	689^PDMP A dministrat or Denied
9823	"DATA",900 2313.93,11 50,0)
9824	690^PDMP: Pharmacy n ot contrac ted
9825	"DATA",900 2313.93,11 51,0)
9826	691^PDMP: Pharmacy c ontract no t renewed
9827	"DATA",900 2313.93,11 52,0)
9828	692^PDMP: M/I Patien t First Na me
9829	"DATA",900 2313.93,11 53,0)
9830	693^PDMP: M/I Patien t Last Nam e
9831	"DATA",900 2313.93,11 54,0)
9832	694^PDMP: M/I Patien t Street A ddress
9833	"DATA",900 2313.93,11 55,0)
9834	695^PDMP: M/I Patien t City
9835	"DATA",900 2313.93,11 56,0)
9836	696^PDMP: M/I Patien t State or Province
9837	"DATA",900 2313.93,11 57,0)
9838	697^PDMP: M/I Patien t ZIP/Post al Code
9839	"DATA",900 2313.93,11 58,0)
9840	698^PDMP: M/I Prescr iber ID
9841	"DATA",900 2313.93,11 59,0)
9842	699^PDMP: M/I Prescr iber Last Name
9843	"DATA",900 2313.93,11 60,0)
9844	700^PDMP: M/I Patien t ID
9845	"DATA",900 2313.93,11 61,0)
9846	701^PDMP: M/I Patien t Date of Birth
9847	"DATA",900 2313.93,11 62,0)
9848	702^PDMP: M/I Patien t Gender
9849	"DATA",900 2313.93,11 63,0)
9850	703^PDMP: M/I Prescr iption Ori gin Code
9851	"DATA",900 2313.93,11 64,0)
9852	704^PDMP: M/I Schedu led Rx Ser ial Number
9853	"DATA",900 2313.93,11 65,0)
9854	705^PDMP: M/I Produc t/Service ID
9855	"DATA",900 2313.93,11 66,0)
9856	706^PDMP: M/I Compou nd Code
9857	"DATA",900 2313.93,11 67,0)
9858	707^PDMP: M/I Patien t Phone Nu mber
9859	"DATA",900 2313.93,11 68,0)
9860	708^PDMP: M/I Paymen t Code
9861	"DATA",900 2313.93,11 69,0)
9862	769^Medica re PartD P d claim fo und, Info Report Rev ersal/Rebi ll not mat ched
9863	"DATA",900 2313.93,11 70,0)
9864	770^Medica re Part D Pd claim n ot found, Info Repor t Reversal not proce ssed
9865	"DATA",900 2313.93,11 71,0)
9866	771^Compou nd contain s unidenti fiable ing redient; S CC overrid e not allo wed
9867	"DATA",900 2313.93,11 72,0)
9868	772^Compou nd not pay able due t o non-cove red ingred ient;no ov erride all owed
9869	"DATA",900 2313.93,11 73,0)
9870	773^Prescr iber Is No t Listed O n Medicare Enrollmen t File
9871	"DATA",900 2313.93,11 74,0)
9872	774^Prescr iber Medic are Enroll ment Perio d Is Outsi de Of Clai m Date Of Serv
9873	"DATA",900 2313.93,11 75,0)
9874	775^Pharma cy not lis ted within Medicare Fee For Se rvice enro llment fil e
9875	"DATA",900 2313.93,11 76,0)
9876	776^Pharma cy enrollm ent with M edicare Fe e For Serv ice has te rminated
9877	"DATA",900 2313.93,11 77,0)
9878	777^Plan's Prescribe r data bas e not able to verify active st ate licens e
9879	"DATA",900 2313.93,11 78,0)
9880	A3^This Pr oduct May Be Covered Under Hos pice - Med icare A
9881	"DATA",900 2313.93,11 79,0)
9882	A4^Prod Ma y Be Cover ed Under M edicare-B Bndld Pymt ESRD Dial ysis Facil ity
9883	"DATA",900 2313.93,11 80,0)
9884	710^Date R eceived Af ter Reques ted Respon se Date
9885	"DATA",900 2313.93,11 81,0)
9886	711^M/I Tr ansmission Date
9887	"DATA",900 2313.93,11 82,0)
9888	712^M/I Se nding Enti ty Identif ier
9889	"DATA",900 2313.93,11 83,0)
9890	713^M/I Re ceiver ID
9891	"DATA",900 2313.93,11 84,0)
9892	714^M/I Tr ansmission File Type
9893	"DATA",900 2313.93,11 85,0)
9894	715^M/I Tr ansmission Type
9895	"DATA",900 2313.93,11 86,0)
9896	716^Transm ission Fil e Type Not Supported
9897	"DATA",900 2313.93,11 87,0)
9898	717^M/I Su bmission N umber
9899	"DATA",900 2313.93,11 88,0)
9900	718^M/I Au dit Reques t Type
9901	"DATA",900 2313.93,11 89,0)
9902	719^Audit Request Ty pe Not Sup ported
9903	"DATA",900 2313.93,11 90,0)
9904	720^M/I Se rvice Prov ider Chain Code
9905	"DATA",900 2313.93,11 91,0)
9906	721^M/I En tity Name
9907	"DATA",900 2313.93,11 92,0)
9908	722^M/I En tity Conta ct First N ame
9909	"DATA",900 2313.93,11 93,0)
9910	723^M/I En tity Conta ct Last Na me
9911	"DATA",900 2313.93,11 94,0)
9912	724^M/I En tity Addre ss Line 1
9913	"DATA",900 2313.93,11 95,0)
9914	725^M/I En tity Addre ss Line 2
9915	"DATA",900 2313.93,11 96,0)
9916	726^M/I En tity City
9917	"DATA",900 2313.93,11 97,0)
9918	727^M/I En tity State /Province Address
9919	"DATA",900 2313.93,11 98,0)
9920	728^M/I En tity Zip/P ostal Code
9921	"DATA",900 2313.93,11 99,0)
9922	729^M/I En tity Fax N umber
9923	"DATA",900 2313.93,12 00,0)
9924	730^M/I En tity Email
9925	"DATA",900 2313.93,12 01,0)
9926	731^Header Response Status Not Supported for this Transmissi on File Ty pe
9927	"DATA",900 2313.93,12 02,0)
9928	732^Reject Code Not Supported for this T ransmissio n File Typ e
9929	"DATA",900 2313.93,12 03,0)
9930	733^M/I Cl aim Sequen ce Number
9931	"DATA",900 2313.93,12 04,0)
9932	734^M/I Au dit Contro l Identifi cation
9933	"DATA",900 2313.93,12 05,0)
9934	735^M/I Au dit Range Qualifier
9935	"DATA",900 2313.93,12 06,0)
9936	736^Audit Range Qual ifier Not Supported for this A udit Reque st Type
9937	"DATA",900 2313.93,12 07,0)
9938	737^M/I Au dit Range Start
9939	"DATA",900 2313.93,12 08,0)
9940	738^Audit Range Star t Not Supp orted for this Audit Request T ype
9941	"DATA",900 2313.93,12 09,0)
9942	739^M/I Au dit Range End
9943	"DATA",900 2313.93,12 10,0)
9944	740^Audit Range End Not Suppor ted for th is Audit R equest Typ e
9945	"DATA",900 2313.93,12 11,0)
9946	741^Exceed s Range St art Limita tions
9947	"DATA",900 2313.93,12 12,0)
9948	742^Exceed s Range En d Limitati ons
9949	"DATA",900 2313.93,12 13,0)
9950	743^M/I Re quested Re sponse Dat e
9951	"DATA",900 2313.93,12 14,0)
9952	744^Respon se Date Re quires Res cheduling
9953	"DATA",900 2313.93,12 15,0)
9954	745^M/I Es timated Ar rival Time Descripti on
9955	"DATA",900 2313.93,12 16,0)
9956	746^Estima ted Arriva l Time Req uires Resc heduling
9957	"DATA",900 2313.93,12 17,0)
9958	747^M/I Au dit Sponso r
9959	"DATA",900 2313.93,12 18,0)
9960	748^Non-Ma tched Proc essor Cont rol Number
9961	"DATA",900 2313.93,12 19,0)
9962	749^M/I Au dit Elemen t Type 1
9963	"DATA",900 2313.93,12 20,0)
9964	750^M/I Au dit Elemen t Type 2
9965	"DATA",900 2313.93,12 21,0)
9966	751^M/I Au dit Elemen t Type 3
9967	"DATA",900 2313.93,12 22,0)
9968	752^M/I Au dit Elemen t Type 4
9969	"DATA",900 2313.93,12 23,0)
9970	753^M/I Au dit Elemen t Type 5
9971	"DATA",900 2313.93,12 24,0)
9972	754^Audit Element Ty pe not all owable per State Reg ulation
9973	"DATA",900 2313.93,12 25,0)
9974	755^Audit Element Ty pe not req uired for dispensing
9975	"DATA",900 2313.93,12 26,0)
9976	756^M/I Au dit Elemen t Response Type 1
9977	"DATA",900 2313.93,12 27,0)
9978	757^M/I Au dit Elemen t Response Type 2
9979	"DATA",900 2313.93,12 28,0)
9980	758^M/I Au dit Elemen t Response Type 3
9981	"DATA",900 2313.93,12 29,0)
9982	759^M/I Au dit Elemen t Response Type 4
9983	"DATA",900 2313.93,12 30,0)
9984	760^M/I Au dit Elemen t Response Type 5
9985	"DATA",900 2313.93,12 31,0)
9986	761^M/I Di screpancy Code 1
9987	"DATA",900 2313.93,12 32,0)
9988	762^M/I Di screpancy Code 2
9989	"DATA",900 2313.93,12 33,0)
9990	763^M/I Di screpancy Code 3
9991	"DATA",900 2313.93,12 34,0)
9992	764^M/I Di screpancy Message
9993	"DATA",900 2313.93,12 35,0)
9994	765^M/I Di screpancy Amount
9995	"DATA",900 2313.93,12 36,0)
9996	766^Discre pancy Amou nt in exce ss of Clai med Amount
9997	"DATA",900 2313.93,12 37,0)
9998	767^M/I Re cord Count
9999	"DATA",900 2313.93,12 38,0)
10000	768^Pharma cy Locatio n has clos ed
10001	"DATA",900 2313.93,12 39,0)
10002	778^Invali d Transmis sion File Type
10003	"DATA",900 2313.93,12 40,0)
10004	779^Invali d Document Reference Number
10005	"DATA",900 2313.93,12 41,0)
10006	780^M/I Tr ansmission Time
10007	"DATA",900 2313.93,12 42,0)
10008	781^Corrup ted Transm ission Con trol Numbe r
10009	"DATA",900 2313.93,12 43,0)
10010	782^M/I Se nder ID
10011	"DATA",900 2313.93,12 44,0)
10012	783^M/I Re ceiver ID
10013	"DATA",900 2313.93,12 45,0)
10014	784^M/I Fi le Type
10015	"DATA",900 2313.93,12 46,0)
10016	785^M/I Su bmission N umber
10017	"DATA",900 2313.93,12 47,0)
10018	786^M/I Tr ansmission Date
10019	"DATA",900 2313.93,12 48,0)
10020	787^M/I Ac cumulator Balance Co unt
10021	"DATA",900 2313.93,12 49,0)
10022	788^M/I Ac cumulator Network In dicator
10023	"DATA",900 2313.93,12 50,0)
10024	789^M/I Ac cumulator Action Cod e
10025	"DATA",900 2313.93,12 51,0)
10026	790^M/I Be nefit Type
10027	"DATA",900 2313.93,12 52,0)
10028	791^M/I In Network S tatus
10029	"DATA",900 2313.93,12 53,0)
10030	792^Duplic ate Record
10031	"DATA",900 2313.93,12 54,0)
10032	793^Retry Limit Exce eded
10033	"DATA",900 2313.93,12 55,0)
10034	794^Deduct ible Over Accumulate d
10035	"DATA",900 2313.93,12 56,0)
10036	795^Out Of Pocked Ov er Accumul ated
10037	"DATA",900 2313.93,12 57,0)
10038	796^Maximu m Benefit Amount (CA P) Over Ac cumulated
10039	"DATA",900 2313.93,12 58,0)
10040	797^Corrup ted Transm ission Con trol Numbe r
10041	"DATA",900 2313.93,12 59,0)
10042	798^SA Ove r Accumula ted
10043	"DATA",900 2313.93,12 60,0)
10044	799^LTC Ov er Accumul ated
10045	"DATA",900 2313.93,12 61,0)
10046	800^RXC Ov er Accumul ated
10047	"DATA",900 2313.93,12 62,0)
10048	801^M/I To tal Amount Paid
10049	"DATA",900 2313.93,12 63,0)
10050	802^M/I Am ount of Co pay
10051	"DATA",900 2313.93,12 64,0)
10052	803^M/I Pa tient Pay Amount
10053	"DATA",900 2313.93,12 65,0)
10054	804^M/I Am ount Attri buted to P roduct Sel ection/Bra nd
10055	"DATA",900 2313.93,12 66,0)
10056	805^M/I Am ount Attri buted to S ales Tax
10057	"DATA",900 2313.93,12 67,0)
10058	806^M/I Am ount Attri buted to P rocess Fee
10059	"DATA",900 2313.93,12 68,0)
10060	807^M/I In voiced Amo unt
10061	"DATA",900 2313.93,12 69,0)
10062	808^M/I Pe nalty Amou nt
10063	"DATA",900 2313.93,12 70,0)
10064	809^Mismat ched Origi nal Author ization
10065	"DATA",900 2313.93,12 71,0)
10066	810^M/I Pa rtner Elig ibility Da ta
10067	"DATA",900 2313.93,12 72,0)
10068	811^Partne r Eligibil ity Mismat ch
10069	"DATA",900 2313.93,12 73,0)
10070	812^M/I Re cord Lengt h
10071	"DATA",900 2313.93,12 74,0)
10072	813^M/I Ac tion Code
10073	"DATA",900 2313.93,12 75,0)
10074	814^Not Su pported Ac cumulator Action Cod e
10075	"DATA",900 2313.93,12 76,0)
10076	815^Balanc e Mismatch
10077	"DATA",900 2313.93,12 77,0)
10078	816^Pharma cy Benefit Exclusion , May Be C overed Und er Pt's Me dical Bene fit
10079	"DATA",900 2313.93,12 78,0)
10080	817^Pharma cy Benefit Exclusion , Covered Under Pati ent's Medi cal Benefi t
10081	"DATA",900 2313.93,12 79,0)
10082	818^Medica tion Admin istration Not Covere d, Plan Be nefit Excl usion
10083	"DATA",900 2313.93,12 80,0)
10084	819^Plan E nrollment File Indic ates Medic are As Pri mary Cover age
10085	"DATA",900 2313.93,12 81,0)
10086	820^Info R eporting T rans mtchd to Rev/Re j Clm not Submitted Part D BIN PCN
10087	"DATA",900 2313.93,12 82,0)
10088	821^Info R eporting T rans Mtchd to Pd Clm Not Submi tted Part D BIN PCN
10089	"DATA",900 2313.93,12 83,0)
10090	822^Drug U nrelated T o The Term inal Illne ss &/Or Re l Cond. No Hospice C ov
10091	"DATA",900 2313.93,12 84,0)
10092	823^Drug I s Benef Li ability-No t Cov By H ospice. Ho sp Non-For m. Chk Oth Cov
10093	"DATA",900 2313.93,12 85,0)
10094	824^Multi- transactio n transmis sion not a llowed in current NC PDP standa rd
10095	"DATA",900 2313.93,12 86,0)
10096	825^Claim Date Of Se rvice Is O utside Of Product's FDA/NSDE M arketing D ates
10097	"DATA",900 2313.93,12 87,0)
10098	826^Prescr iber NPI S ubmitted N ot Found W ithin Proc essor's NP I File
10099	"DATA",900 2313.93,12 88,0)
10100	827^Pharm Serv Prov Is Temp Su spnded Fro m Processi ng Clms By Payer/Pro cess
10101	"DATA",900 2313.93,12 89,0)
10102	828^Plan/B eneficiary Case Mana gement Res triction I n Place
10103	"DATA",900 2313.93,12 90,0)
10104	829^Clm No t Cov Due To Failure To Meet P art D Pres criber NPI Requireme nts
10105	"DATA",900 2313.93,12 91,0)
10106	830^Worker s' Comp Or P&C Adjus ter Auth R equired-Pt Must Cont act Adjust er
10107	"DATA",900 2313.93,12 92,0)
10108	831^Produc t Service ID Carve-O ut, Bill M edicaid Fe e For Serv ice
10109	"DATA",900 2313.93,12 93,0)
10110	832^Prescr iber NPI N ot Found - NPI, MEDI CARE, RX A uthority N ot Validat ed
10111	"DATA",900 2313.93,12 94,0)
10112	833^Accumu lator Year Is Not Wi thin ATBT Timeframe
10113	"DATA",900 2313.93,12 95,0)
10114	834^M/I Pr ovider Fir st Name
10115	"DATA",900 2313.93,12 96,0)
10116	835^M/I Pr ovider Las t Name
10117	"DATA",900 2313.93,12 97,0)
10118	836^M/I Fa cility ID Qualifier
10119	"DATA",900 2313.93,12 98,0)
10120	837^Facili ty ID Valu e Not Supp orted
10121	"DATA",900 2313.93,12 99,0)
10122	838^M/I Or iginal Man ufacturer Product ID
10123	"DATA",900 2313.93,13 00,0)
10124	839^M/I Or iginal Man ufacturer Product ID Qualifier
10125	"DATA",900 2313.93,13 01,0)
10126	840^Origin al Manufac turer Prod uct ID Val ue Not Sup ported
10127	"FIA",9002 313.02)
10128	BPS CLAIMS
10129	"FIA",9002 313.02,0)
10130	^BPSC(
10131	"FIA",9002 313.02,0,0 )
10132	9002313.02
10133	"FIA",9002 313.02,0,1 )
10134	y^n^p^^^^n ^^n
10135	"FIA",9002 313.02,0,1 0)
10136
10137	"FIA",9002 313.02,0,1 1)
10138
10139	"FIA",9002 313.02,0," RLRO")
10140
10141	"FIA",9002 313.02,0," VR")
10142	1.0^BPS
10143	"FIA",9002 313.02,900 2313.02)
10144	1
10145	"FIA",9002 313.02,900 2313.0201)
10146	1
10147	"FIA",9002 313.02,900 2313.0201, 2096)
10148
10149	"FIA",9002 313.02,900 2313.0201, 2097)
10150
10151	"FIA",9002 313.02,900 2313.0201, 2101)
10152
10153	"FIA",9002 313.02,900 2313.0201, 2102)
10154
10155	"FIA",9002 313.25)
10156	BPS NCPDP CLARIFICAT ION CODES
10157	"FIA",9002 313.25,0)
10158	^BPS(90023 13.25,
10159	"FIA",9002 313.25,0,0 )
10160	9002313.25 I
10161	"FIA",9002 313.25,0,1 )
10162	y^n^f^^n^^ y^o^n
10163	"FIA",9002 313.25,0,1 0)
10164
10165	"FIA",9002 313.25,0,1 1)
10166
10167	"FIA",9002 313.25,0," RLRO")
10168
10169	"FIA",9002 313.25,0," VR")
10170	1.0^BPS
10171	"FIA",9002 313.25,900 2313.25)
10172	0
10173	"FIA",9002 313.91)
10174	BPS NCPDP FIELD DEFS
10175	"FIA",9002 313.91,0)
10176	^BPSF(9002 313.91,
10177	"FIA",9002 313.91,0,0 )
10178	9002313.91 I
10179	"FIA",9002 313.91,0,1 )
10180	y^n^f^^n^^ y^o^n
10181	"FIA",9002 313.91,0,1 0)
10182
10183	"FIA",9002 313.91,0,1 1)
10184
10185	"FIA",9002 313.91,0," RLRO")
10186
10187	"FIA",9002 313.91,0," VR")
10188	1.0^BPS
10189	"FIA",9002 313.91,900 2313.91)
10190	0
10191	"FIA",9002 313.91,900 2313.9101)
10192	0
10193	"FIA",9002 313.91,900 2313.9102)
10194	0
10195	"FIA",9002 313.91,900 2313.9103)
10196	0
10197	"FIA",9002 313.91,900 2313.9104)
10198	0
10199	"FIA",9002 313.93)
10200	BPS NCPDP REJECT COD ES
10201	"FIA",9002 313.93,0)
10202	^BPSF(9002 313.93,
10203	"FIA",9002 313.93,0,0 )
10204	9002313.93 I
10205	"FIA",9002 313.93,0,1 )
10206	y^n^f^^n^^ y^o^n
10207	"FIA",9002 313.93,0,1 0)
10208
10209	"FIA",9002 313.93,0,1 1)
10210
10211	"FIA",9002 313.93,0," RLRO")
10212
10213	"FIA",9002 313.93,0," VR")
10214	1.0^BPS
10215	"FIA",9002 313.93,900 2313.93)
10216	0
10217	"INI")
10218	EN^BPS21PR E
10219	"MBREQ")
10220	0
10221	"PKG",632, -1)
10222	1^1
10223	"PKG",632, 0)
10224	E CLAIMS M GMT ENGINE ^BPS^ELECT RONIC CLAI MS MGT
10225	"PKG",632, 20,0)
10226	^9.402P^^
10227	"PKG",632, 22,0)
10228	^9.49I^1^1
10229	"PKG",632, 22,1,0)
10230	1.0^304100 8^3041130^ 568
10231	"PKG",632, 22,1,"PAH" ,1,0)
10232	21^3170605
10233	"PKG",632, 22,1,"PAH" ,1,1,0)
10234	^^1^1^3170 605
10235	"PKG",632, 22,1,"PAH" ,1,1,1,0)
10236	MCCF EDI T AS ePharma cy Iterati on 1
10237	"QUES","XP F1",0)
10238	Y
10239	"QUES","XP F1","??")
10240	^D REP^XPD H
10241	"QUES","XP F1","A")
10242	Shall I wr ite over y our \|FLAG\| File
10243	"QUES","XP F1","B")
10244	YES
10245	"QUES","XP F1","M")
10246	D XPF1^XPD IQ
10247	"QUES","XP F2",0)
10248	Y
10249	"QUES","XP F2","??")
10250	^D DTA^XPD H
10251	"QUES","XP F2","A")
10252	Want my da ta \|FLAG\| yours
10253	"QUES","XP F2","B")
10254	YES
10255	"QUES","XP F2","M")
10256	D XPF2^XPD IQ
10257	"QUES","XP I1",0)
10258	YO
10259	"QUES","XP I1","??")
10260	^D INHIBIT ^XPDH
10261	"QUES","XP I1","A")
10262	Want KIDS to INHIBIT LOGONs du ring the i nstall
10263	"QUES","XP I1","B")
10264	NO
10265	"QUES","XP I1","M")
10266	D XPI1^XPD IQ
10267	"QUES","XP M1",0)
10268	PO^VA(200, :EM
10269	"QUES","XP M1","??")
10270	^D MG^XPDH
10271	"QUES","XP M1","A")
10272	Enter the Coordinato r for Mail Group '\|F LAG\|'
10273	"QUES","XP M1","B")
10274
10275	"QUES","XP M1","M")
10276	D XPM1^XPD IQ
10277	"QUES","XP O1",0)
10278	Y
10279	"QUES","XP O1","??")
10280	^D MENU^XP DH
10281	"QUES","XP O1","A")
10282	Want KIDS to Rebuild Menu Tree s Upon Com pletion of Install
10283	"QUES","XP O1","B")
10284	NO
10285	"QUES","XP O1","M")
10286	D XPO1^XPD IQ
10287	"QUES","XP Z1",0)
10288	Y
10289	"QUES","XP Z1","??")
10290	^D OPT^XPD H
10291	"QUES","XP Z1","A")
10292	Want to DI SABLE Sche duled Opti ons, Menu Options, a nd Protoco ls
10293	"QUES","XP Z1","B")
10294	NO
10295	"QUES","XP Z1","M")
10296	D XPZ1^XPD IQ
10297	"QUES","XP Z2",0)
10298	Y
10299	"QUES","XP Z2","??")
10300	^D RTN^XPD H
10301	"QUES","XP Z2","A")
10302	Want to MO VE routine s to other CPUs
10303	"QUES","XP Z2","B")
10304	NO
10305	"QUES","XP Z2","M")
10306	D XPZ2^XPD IQ
10307	"RTN")
10308	4
10309	"RTN","BPS 21PRE")
10310	0^^B102715 21^n/a
10311	"RTN","BPS 21PRE",1,0 )
10312	BPS21PRE ; AITC/CKB - Pre-insta llroutine for BPS1 21 ;2/21/2 017
10313	"RTN","BPS 21PRE",2,0 )
10314	;;1.0;E C LAIMS MGMT ENGINE; 21;JUN 2 004;Build 28
10315	"RTN","BPS 21PRE",3,0 )
10316	;;Per VA Directive 6402, this routine s hould not be modifie d.
10317	"RTN","BPS 21PRE",4,0 )
10318	;
10319	"RTN","BPS 21PRE",5,0 )
10320	; MCCF ED I TAS ePha rmacy Iter ation 1 - BPS121 p atch pre-i nstall
10321	"RTN","BPS 21PRE",6,0 )
10322	Q
10323	"RTN","BPS 21PRE",7,0 )
10324	;
10325	"RTN","BPS 21PRE",8,0 )
10326	EN ; Entry Point for pre-insta ll
10327	"RTN","BPS 21PRE",9,0 )
10328	D MES^XPD UTL(" Sta rting pre- install fo r BPS121 ")
10329	"RTN","BPS 21PRE",10, 0)
10330	;
10331	"RTN","BPS 21PRE",11, 0)
10332	; Update descriptio ns in the BPS NCPDP FIELD DEF file #9002 313.91
10333	"RTN","BPS 21PRE",12, 0)
10334	D FIELDS
10335	"RTN","BPS 21PRE",13, 0)
10336	;
10337	"RTN","BPS 21PRE",14, 0)
10338	; Update Reject cod es in BPS NCPDP REJE CT CODES f ile #90023 13.93
10339	"RTN","BPS 21PRE",15, 0)
10340	D REJECTS
10341	"RTN","BPS 21PRE",16, 0)
10342	;
10343	"RTN","BPS 21PRE",17, 0)
10344	EX ; Exit point
10345	"RTN","BPS 21PRE",18, 0)
10346	D MES^XPD UTL(" Fin ished pre- install of BPS121" )
10347	"RTN","BPS 21PRE",19, 0)
10348	Q
10349	"RTN","BPS 21PRE",20, 0)
10350	;
10351	"RTN","BPS 21PRE",21, 0)
10352	FIELDS ; U pdate Fiel ds Defs wi th new des criptions
10353	"RTN","BPS 21PRE",22, 0)
10354	N LINE,DA TA,NUM,NAM E,DA,DIE,D R,CNT
10355	"RTN","BPS 21PRE",23, 0)
10356	D MES^XPD UTL(" - Up dating BPS NCPDP FIE LD DEFS")
10357	"RTN","BPS 21PRE",24, 0)
10358	S CNT=0
10359	"RTN","BPS 21PRE",25, 0)
10360	F LINE=1: 1 S DATA=$ P($T(NFLDS +LINE),";; ",2,99) Q :DATA="" D
10361	"RTN","BPS 21PRE",26, 0)
10362	. S DIE=9 002313.91, NUM=$P(DAT A,";",1)
10363	"RTN","BPS 21PRE",27, 0)
10364	. S DA=$O (^BPSF(DIE ,"B",NUM," "))
10365	"RTN","BPS 21PRE",28, 0)
10366	. I 'DA D MES^XPDUT L(" - No IEN found for entry "_NUM) Q
10367	"RTN","BPS 21PRE",29, 0)
10368	. S NAME= $P(DATA,"; ",2),DR=". 03////^S X =NAME",CNT =CNT+1
10369	"RTN","BPS 21PRE",30, 0)
10370	. D ^DIE
10371	"RTN","BPS 21PRE",31, 0)
10372	D MES^XPD UTL(" - "_CNT_" en tries upda ted")
10373	"RTN","BPS 21PRE",32, 0)
10374	D MES^XPD UTL(" - Do ne with BP S NCPDP FI ELD DEFS")
10375	"RTN","BPS 21PRE",33, 0)
10376	D MES^XPD UTL(" ")
10377	"RTN","BPS 21PRE",34, 0)
10378	Q
10379	"RTN","BPS 21PRE",35, 0)
10380	;
10381	"RTN","BPS 21PRE",36, 0)
10382	NFLDS ; Up dated fiel d names
10383	"RTN","BPS 21PRE",37, 0)
10384	;;409;ING REDIENT CO ST SUBMITT ED
10385	"RTN","BPS 21PRE",38, 0)
10386	;;431;OTH ER PAYER A MOUNT PAID
10387	"RTN","BPS 21PRE",39, 0)
10388	;;433;PAT IENT PAID AMOUNT SUB MITTED
10389	"RTN","BPS 21PRE",40, 0)
10390	;;579;ASS OC RX/SERV ICE PROV I D QUAL
10391	"RTN","BPS 21PRE",41, 0)
10392	;;580;ASS OC RX/SERV ICE PROVID ER ID
10393	"RTN","BPS 21PRE",42, 0)
10394	;;581;ASS OC RX/SERV ICE REF NU M QUAL
10395	"RTN","BPS 21PRE",43, 0)
10396	;;582;ASS OC RX/SERV ICE FILL N UMBER
10397	"RTN","BPS 21PRE",44, 0)
10398	;
10399	"RTN","BPS 21PRE",45, 0)
10400	;
10401	"RTN","BPS 21PRE",46, 0)
10402	REJECTS ; Update Rej ect Codes with new e xplanation s
10403	"RTN","BPS 21PRE",47, 0)
10404	N LINE,DA TA,NUM,NAM E,DA,DIE,D R,CNT
10405	"RTN","BPS 21PRE",48, 0)
10406	D MES^XPD UTL(" - Updating BPS NCPDP REJECT COD ES")
10407	"RTN","BPS 21PRE",49, 0)
10408	S CNT=0
10409	"RTN","BPS 21PRE",50, 0)
10410	F LINE=1: 1 S DATA=$ P($T(NRJCT +LINE),";; ",2,99) Q: DATA="" D
10411	"RTN","BPS 21PRE",51, 0)
10412	. S DIE=9 002313.93, NUM=$P(DAT A,";",1)
10413	"RTN","BPS 21PRE",52, 0)
10414	. S DA=$O (^BPSF(DIE ,"B",NUM," "))
10415	"RTN","BPS 21PRE",53, 0)
10416	. I 'DA D MES^XPDUT L(" - No IEN found for entry "_NUM) Q
10417	"RTN","BPS 21PRE",54, 0)
10418	. S NAME= $P(DATA,"; ",2),DR=". 02////^S X =NAME",CNT =CNT+1
10419	"RTN","BPS 21PRE",55, 0)
10420	. D ^DIE
10421	"RTN","BPS 21PRE",56, 0)
10422	D MES^XPD UTL(" - "_CNT_" entries u pdated")
10423	"RTN","BPS 21PRE",57, 0)
10424	D MES^XPD UTL(" - Done with BPS NCPDP REJECT CO DES")
10425	"RTN","BPS 21PRE",58, 0)
10426	D MES^XPD UTL(" ")
10427	"RTN","BPS 21PRE",59, 0)
10428	Q
10429	"RTN","BPS 21PRE",60, 0)
10430	;
10431	"RTN","BPS 21PRE",61, 0)
10432	NRJCT ; Up dated reje ct explana tions
10433	"RTN","BPS 21PRE",62, 0)
10434	;;280;Pri or Authori zation ID Submitted is not use d for this Transacti on Code
10435	"RTN","BPS 21PRE",63, 0)
10436	;;EV;M/I Prior Auth orization ID Submitt ed
10437	"RTN","BPS 21PRE",64, 0)
10438	;;N7;Use Prior Auth orization ID Provide d During T ransition Period
10439	"RTN","BPS 21PRE",65, 0)
10440	;;N8;Use Prior Auth orization ID Provide d For Emer gency Fill
10441	"RTN","BPS 21PRE",66, 0)
10442	;;N9;Use Prior Auth orization ID Provide d For Leve l of Care Change
10443	"RTN","BPS 21PRE",67, 0)
10444	;;635;Emp loyer Coun try Code V alue Not S upported
10445	"RTN","BPS 21PRE",68, 0)
10446	;;637;Ent ity Countr y Code Val ue Not Sup ported
10447	"RTN","BPS 21PRE",69, 0)
10448	;;638;Fac ility Coun try Code V alue Not S upported
10449	"RTN","BPS 21PRE",70, 0)
10450	;;639;Pat ient ID As sociated C ountry Cod e Value No t Supporte d
10451	"RTN","BPS 21PRE",71, 0)
10452	;;640;Pay to Countr y Code Val ue Not Sup ported
10453	"RTN","BPS RES")
10454	0^2^B20502 3095^B1590 42443
10455	"RTN","BPS RES",1,0)
10456	BPSRES ;BH AM ISC/BEE - ECME SC REEN RESUB MIT W/EDIT S ;3/12/08 14:01
10457	"RTN","BPS RES",2,0)
10458	;;1.0;E C LAIMS MGMT ENGINE;** 3,5,7,8,10 ,11,20,21* *;JUN 2004 ;Build 28
10459	"RTN","BPS RES",3,0)
10460	;;Per VA Directive 6402, this routine s hould not be modifie d.
10461	"RTN","BPS RES",4,0)
10462	;
10463	"RTN","BPS RES",5,0)
10464	; Referen ce to $$RX RLDT^PSOBP SUT suppor ted by DBI A 4701
10465	"RTN","BPS RES",6,0)
10466	; Referen ce to $$RX FLDT^PSOBP SUT suppor ted by DBI A 4701
10467	"RTN","BPS RES",7,0)
10468	; Referen ce to $$FI ND^PSOREJU T supporte d by DBIA 4706
10469	"RTN","BPS RES",8,0)
10470	; Referen ce to GET^ PSOREJU2 s upported b y DBIA 674 9
10471	"RTN","BPS RES",9,0)
10472	;
10473	"RTN","BPS RES",10,0)
10474	;ECME Res ubmit w/ED ITS Protoc ol (Hidden ) - Called by [BPS U SER SCREEN ]
10475	"RTN","BPS RES",11,0)
10476	;
10477	"RTN","BPS RES",12,0)
10478	RESED N BP SEL
10479	"RTN","BPS RES",13,0)
10480	;
10481	"RTN","BPS RES",14,0)
10482	I '$D(@(V ALMAR)) G XRESED
10483	"RTN","BPS RES",15,0)
10484	D FULL^VA LM1
10485	"RTN","BPS RES",16,0)
10486	;
10487	"RTN","BPS RES",17,0)
10488	;Select t he claim t o resubmit
10489	"RTN","BPS RES",18,0)
10490	W !,"Ente r the line number fo r the clai m to be re submitted. "
10491	"RTN","BPS RES",19,0)
10492	S BPSEL=$ $ASKLINE(" Select ite m","Please select a SINGLE cla im only wh en using t he Resubmi t w/EDITS action opt ion.")
10493	"RTN","BPS RES",20,0)
10494	I BPSEL<1 S VALMBCK ="R" G XRE SED
10495	"RTN","BPS RES",21,0)
10496	;
10497	"RTN","BPS RES",22,0)
10498	;Attempt to resubmi t the clai m, update the conten t of the s creen, and display
10499	"RTN","BPS RES",23,0)
10500	;only if claim subm itted succ essfully
10501	"RTN","BPS RES",24,0)
10502	I $$DOSEL CTD(BPSEL) D REDRAW^ BPSSCRUD(" Updating s creen for resubmitte d claim... ")
10503	"RTN","BPS RES",25,0)
10504	E S VALM BCK="R"
10505	"RTN","BPS RES",26,0)
10506	;
10507	"RTN","BPS RES",27,0)
10508	XRESED Q
10509	"RTN","BPS RES",28,0)
10510	;
10511	"RTN","BPS RES",29,0)
10512	;Attempt to Edit an d Resubmit Selected Claim
10513	"RTN","BPS RES",30,0)
10514	;
10515	"RTN","BPS RES",31,0)
10516	; Input Value -> BPRXI - En try with p tr to BPS TRANSACTIO N file
10517	"RTN","BPS RES",32,0)
10518	;
10519	"RTN","BPS RES",33,0)
10520	; Return Value -> 0 - Claim was not re submitted
10521	"RTN","BPS RES",34,0)
10522	; 1 - Claim was resubm itted
10523	"RTN","BPS RES",35,0)
10524	;
10525	"RTN","BPS RES",36,0)
10526	DOSELCTD(B PRXI) ;
10527	"RTN","BPS RES",37,0)
10528	N BP02,BP 59,BPBILL, BPCLTOT,BP DFN,BPDOSD T,BPOVRIEN ,BPQ,BPRXI EN,BPRXR,B PSTATUS,BP UPDFLG
10529	"RTN","BPS RES",38,0)
10530	N BPCOB,B PSURE,BPPT RES,BPPHSR V,BPDLYRS, COBDATA,BP PRIOPN,BPS PCLS
10531	"RTN","BPS RES",39,0)
10532	S (BPQ)=" "
10533	"RTN","BPS RES",40,0)
10534	S (BPCLTO T,BPUPDFLG )=0
10535	"RTN","BPS RES",41,0)
10536	;
10537	"RTN","BPS RES",42,0)
10538	;Pull BPS TRANSACTI ON/BPS CLA IMS entrie s
10539	"RTN","BPS RES",43,0)
10540	S BP59=$P (BPRXI,U,4 ) I BP59=" " W !!,"No Initial C laim Submi ssion Foun d - Data E lements ar e NOT Edit able for R e-Submissi on",! G XR ES
10541	"RTN","BPS RES",44,0)
10542	;
10543	"RTN","BPS RES",45,0)
10544	; check f or non-bil lable entr y
10545	"RTN","BPS RES",46,0)
10546	I $$NB^BP SSCR03(BP5 9) W !!,"E ntry is NO N BILLABLE . There i s no claim to edit o r resubmit .",! G XRE S
10547	"RTN","BPS RES",47,0)
10548	;
10549	"RTN","BPS RES",48,0)
10550	S BP02=+$ P($G(^BPST (BP59,0)), U,4) I 'BP 02 W !!,"N o Initial Claim Subm ission Fou nd - Data Elements a re NOT Edi table for Re-Submiss ion",! G X RES
10551	"RTN","BPS RES",49,0)
10552	;
10553	"RTN","BPS RES",50,0)
10554	;Write Fo rm Feed
10555	"RTN","BPS RES",51,0)
10556	W @IOF
10557	"RTN","BPS RES",52,0)
10558	;
10559	"RTN","BPS RES",53,0)
10560	;Display selected c laim and a sk to subm it
10561	"RTN","BPS RES",54,0)
10562	S BPDFN=+ $P($G(^BPS T(BP59,0)) ,U,6)
10563	"RTN","BPS RES",55,0)
10564	W !,"You' ve chosen to RESUBMI T the foll owing pres cription f or "_$E($$ PATNAME^BP SSCRU2(BPD FN),1,13)
10565	"RTN","BPS RES",56,0)
10566	W !,@VALM AR@(+$P(BP RXI,U,5),0 )
10567	"RTN","BPS RES",57,0)
10568	S BPQ=$$Y ESNO^BPSSC RRS("Are y ou sure?(Y /N)")
10569	"RTN","BPS RES",58,0)
10570	I BPQ'=1 S BPQ="^" G XRES
10571	"RTN","BPS RES",59,0)
10572	;
10573	"RTN","BPS RES",60,0)
10574	;Check to make sure claim can be Resubm itted w/ED ITS
10575	"RTN","BPS RES",61,0)
10576	S BPRXIEN =$P(BP59," .")
10577	"RTN","BPS RES",62,0)
10578	S BPRXR=+ $E($P(BP59 ,".",2),1, 4)
10579	"RTN","BPS RES",63,0)
10580	I $$RXDEL ^BPSOS($P( BP59,".",1 ),+$E($P(B P59,".",2) ,1,4)) W ! !,"The cla im: ",!,@V ALMAR@(+$P (BPRXI,U,5 ),0),!,"ca nnot be Re submitted w/EDITS be cause it h as been de leted in P harmacy.", ! G XRES
10581	"RTN","BPS RES",64,0)
10582	S BPSTATU S=$P($$CLA IMST^BPSSC RU3(BP59), U)
10583	"RTN","BPS RES",65,0)
10584	I BPSTATU S["IN PROG RESS" W !! ,"The clai m: ",!,@VA LMAR@(+$P( BPRXI,U,5) ,0),!,"is still In P rogress an d cannot b e Resubmit ted w/EDIT S",! G XRE S
10585	"RTN","BPS RES",66,0)
10586	I BPSTATU S'["E REJE CTED" W !! ,"The clai m: ",!,@VA LMAR@(+$P( BPRXI,U,5) ,0),!,"is NOT Reject ed and can not be Res ubmitted w /EDITS",! G XRES
10587	"RTN","BPS RES",67,0)
10588	I $P($G(^ BPST(BP59, 0)),U,14)< 2,$$PAYABL E^BPSOSRX5 (BPSTATUS) ,$$PAYBLSE C^BPSUTIL2 (BP59) D G XRES
10589	"RTN","BPS RES",68,0)
10590	. W !,"Th e claim: " ,!,@VALMAR @(+$P(BPRX I,U,5),0), !,"cannot be Resubmi tted if th e secondar y claim is payable." ,!,"Please reverse t he seconda ry claim f irst."
10591	"RTN","BPS RES",69,0)
10592	;
10593	"RTN","BPS RES",70,0)
10594	;Can't re submit a c losed clai m. The use r must reo pen first.
10595	"RTN","BPS RES",71,0)
10596	I $$CLOSE D^BPSSCRU1 (BP59) W ! !,"The cla im: ",!,@V ALMAR@(+$P (BPRXI,U,5 ),0),!,"is Closed an d cannot b e Resubmit ted w/EDIT S.",! G XR ES
10597	"RTN","BPS RES",72,0)
10598	;
10599	"RTN","BPS RES",73,0)
10600	S BPCOB=$ $COB59^BPS UTIL2(BP59 )
10601	"RTN","BPS RES",74,0)
10602	;If this is a secon dary, make sure Prim ary is eit her Payabl e or Close d.
10603	"RTN","BPS RES",75,0)
10604	S BPPRIOP N=0 I BPCO B=2 D G X RES:BPPRIO PN=1
10605	"RTN","BPS RES",76,0)
10606	. ;Get Pr imary clai m status
10607	"RTN","BPS RES",77,0)
10608	. S BPSPC LS=$$FINDE CLM^BPSPRR X5(BPRXIEN ,BPRXR,1)
10609	"RTN","BPS RES",78,0)
10610	. I $P(BP SPCLS,U)>1 D
10611	"RTN","BPS RES",79,0)
10612	.. Q:$$CL OSED^BPSSC RU1($P(BPS PCLS,U,2))
10613	"RTN","BPS RES",80,0)
10614	.. W !,"T he seconda ry claim c annot be R esubmitted unless th e primary is either payable",! ,"or close d. Please resubmit o r close th e primary claim firs t."
10615	"RTN","BPS RES",81,0)
10616	.. S BPPR IOPN=1
10617	"RTN","BPS RES",82,0)
10618	;Retrieve DOS
10619	"RTN","BPS RES",83,0)
10620	S BPDOSDT =$$DOSDATE ^BPSSCRRS( BPRXIEN,BP RXR)
10621	"RTN","BPS RES",84,0)
10622	;
10623	"RTN","BPS RES",85,0)
10624	;Prompt f or EDIT In formation
10625	"RTN","BPS RES",86,0)
10626	S BPOVRIE N=$$PROMPT S(BP59,BP0 2,BPRXIEN, BPRXR,BPCO B,.BPDOSDT ,.COBDATA) I BPOVRIE N=-1 G XRE S
10627	"RTN","BPS RES",87,0)
10628	;
10629	"RTN","BPS RES",88,0)
10630	; Submit the claim
10631	"RTN","BPS RES",89,0)
10632	S BPBILL= $$EN^BPSNC PDP(BPRXIE N,BPRXR,BP DOSDT,"ERE S","","ECM E RESUBMIT ","",BPOVR IEN,"","", BPCOB,"F", "","",$G(C OBDATA("PL AN")),.COB DATA,$G(CO BDATA("RTY PE")))
10633	"RTN","BPS RES",90,0)
10634	;
10635	"RTN","BPS RES",91,0)
10636	;Print Re turn Value Message
10637	"RTN","BPS RES",92,0)
10638	W !!
10639	"RTN","BPS RES",93,0)
10640	W:+BPBILL >0 $S(+BPB ILL=10:"Re versal but no Resubm it:",1:"No t Processe d:"),!," "
10641	"RTN","BPS RES",94,0)
10642	;
10643	"RTN","BPS RES",95,0)
10644	;Change R eturn Mess age for SC /EI
10645	"RTN","BPS RES",96,0)
10646	S:$P(BPBI LL,U,2)="N EEDS SC DE TERMINATIO N" $P(BPBI LL,U,2)="N EEDS SC/EI DETERMINA TION"
10647	"RTN","BPS RES",97,0)
10648	W $P(BPBI LL,U,2)
10649	"RTN","BPS RES",98,0)
10650	;
10651	"RTN","BPS RES",99,0)
10652	;0 Prescr iption/Fil l successf ully submi tted to EC ME
10653	"RTN","BPS RES",100,0 )
10654	;1 ECME d id not sub mit prescr iption/fil l
10655	"RTN","BPS RES",101,0 )
10656	;2 IB say s prescrip tion/fill is not ECM E billable or the da ta returne d from IB is not val id
10657	"RTN","BPS RES",102,0 )
10658	;3 ECME c losed the claim but did not su bmit it to the payer
10659	"RTN","BPS RES",103,0 )
10660	;4 Unable to queue the ECME c laim
10661	"RTN","BPS RES",104,0 )
10662	;5 Invali d input
10663	"RTN","BPS RES",105,0 )
10664	;10 Rever sal Proces sed But Cl aim Was No t Resubmit ted
10665	"RTN","BPS RES",106,0 )
10666	;
10667	"RTN","BPS RES",107,0 )
10668	I +BPBILL =0 D
10669	"RTN","BPS RES",108,0 )
10670	. D ECMEA CT^PSOBPSU 1(+BPRXIEN ,+BPRXR,"C laim resub mitted to 3rd party payer: ECM E USER's S CREEN-"_$S (BPCOB=1:" p",BPCOB=2 :"s",1:"") _$$INSNAME ^BPSSCRU6( BP59))
10671	"RTN","BPS RES",109,0 )
10672	. S BPUPD FLG=1,BPCL TOT=1
10673	"RTN","BPS RES",110,0 )
10674	XRES I BPC LTOT W !,B PCLTOT," c laim",$S(B PCLTOT'=1: "s have",1 :" has")," been resu bmitted.", !
10675	"RTN","BPS RES",111,0 )
10676	D PAUSE^V ALM1
10677	"RTN","BPS RES",112,0 )
10678	Q BPUPDFL G
10679	"RTN","BPS RES",113,0 )
10680	;
10681	"RTN","BPS RES",114,0 )
10682	XRES2 I BP CLTOT W !, BPCLTOT," claim",$S( BPCLTOT'=1 :"s have", 1:" has"), " been res ubmitted." ,!
10683	"RTN","BPS RES",115,0 )
10684	Q BPUPDFL G
10685	"RTN","BPS RES",116,0 )
10686	;Enter ED IT informa tion for c laim
10687	"RTN","BPS RES",117,0 )
10688	;
10689	"RTN","BPS RES",118,0 )
10690	; Input Values -> BP59 - The BPS TRANS ACTION ent ry
10691	"RTN","BPS RES",119,0 )
10692	; BP02 - The BPS CLAIM S entry
10693	"RTN","BPS RES",120,0 )
10694	; BPRXIEN - Prescripti on IEN (#5 2)
10695	"RTN","BPS RES",121,0 )
10696	; BPRXR - Fi ll Number
10697	"RTN","BPS RES",122,0 )
10698	; BPCOB - (o ptional) p ayer seque nce (1-pri mary, 2 -s econdary)
10699	"RTN","BPS RES",123,0 )
10700	; BPDOSDT - Date of Se rvice, pas sed by ref erence
10701	"RTN","BPS RES",124,0 )
10702	; BPSECOND - Array, pa ssed by re ference, o f COB data
10703	"RTN","BPS RES",125,0 )
10704	; Output Value -> BPQ - -1 - The user chose to quit
10705	"RTN","BPS RES",126,0 )
10706	; "" - The user completed the EDITS
10707	"RTN","BPS RES",127,0 )
10708	PROMPTS(BP 59,BP02,BP RXIEN,BPRX R,BPCOB,BP SDOSDT,BPS ECOND) ;
10709	"RTN","BPS RES",128,0 )
10710	N %,BP300 ,BP35401,B PCLCD1,BPC LCD2,BPCLC D3,BPFDA,B PFLD,BPOVR IEN,BPMED, BPMSG,BPPS NCD
10711	"RTN","BPS RES",129,0 )
10712	N BPPREAU T,BPPRETYP ,BPQ,BPREL CD,DIC,DIR ,DIROUT,DT OUT,DUOUT, X,Y,DIRUT, DUP
10713	"RTN","BPS RES",130,0 )
10714	N BPCLCDN ,BPCLCDX,B PSX
10715	"RTN","BPS RES",131,0 )
10716	S BPQ=""
10717	"RTN","BPS RES",132,0 )
10718	I +$G(BPC OB)=0 S BP COB=1
10719	"RTN","BPS RES",133,0 )
10720	;Pull Inf ormation f rom Claim
10721	"RTN","BPS RES",134,0 )
10722	S BP300=$ G(^BPSC(BP 02,300))
10723	"RTN","BPS RES",135,0 )
10724	S BPRELCD =$TR($E($P (BP300,U,6 ),3,99)," ")
10725	"RTN","BPS RES",136,0 )
10726	S BPPSNCD =$TR($E($P (BP300,U,3 ),3,99)," ")
10727	"RTN","BPS RES",137,0 )
10728	S (BPPRET YP,BPPREAU T,BPDLYRS, BPPHSRV)=" "
10729	"RTN","BPS RES",138,0 )
10730	S BPMED=0 F S BPME D=$O(^BPSC (BP02,400, BPMED)) Q: 'BPMED D I BPPREAU T]"" Q
10731	"RTN","BPS RES",139,0 )
10732	. N BP460 S BP460=$ G(^BPSC(BP 02,400,BPM ED,460))
10733	"RTN","BPS RES",140,0 )
10734	. S:BPPRE AUT="" BPP REAUT=$TR( $E($P(BP46 0,U,2),3,9 9)," "),BP PRETYP=$TR ($E($P(BP4 60,U),3,99 )," ")
10735	"RTN","BPS RES",141,0 )
10736	. S:BPDLY RS="" BPDL YRS=$TR($E ($P($G(^BP SC(BP02,40 0,BPMED,35 0)),U,7),3 ,99)," ") I BPDLYRS] "" S BPDLY RS=+BPDLYR S
10737	"RTN","BPS RES",142,0 )
10738	. S:BPPHS RV="" BPPH SRV=$TR($E ($P($G(^BP SC(BP02,40 0,BPMED,14 0)),U,7),3 ,99)," ")
10739	"RTN","BPS RES",143,0 )
10740	. F BP354 01=1:1:3 S @("BPCLCD "_BP35401) =$TR($E($P ($G(^BPSC( BP02,400,B PMED,354.0 1,BP35401, 1)),U),3,9 9)," ")
10741	"RTN","BPS RES",144,0 )
10742	. S BPCLC D1=+BPCLCD 1 I BPCLCD 1=0 S BPCL CD1=1
10743	"RTN","BPS RES",145,0 )
10744	S BPPTRES =$TR($E($P ($G(^BPSC( BP02,380)) ,U,4),3,99 )," ") I B PPTRES="" S BPPTRES= 1
10745	"RTN","BPS RES",146,0 )
10746	S:BPPHSRV ="" BPPHSR V=1
10747	"RTN","BPS RES",147,0 )
10748	;
10749	"RTN","BPS RES",148,0 )
10750	;Relation ship Code
10751	"RTN","BPS RES",149,0 )
10752	N X,DIC,Y
10753	"RTN","BPS RES",150,0 )
10754	S DIC("B" )=BPRELCD
10755	"RTN","BPS RES",151,0 )
10756	S DIC(0)= "QEAM",DIC =9002313.1 9,DIC("A") ="Pharmacy Relations hip Code: "
10757	"RTN","BPS RES",152,0 )
10758	D ^DIC
10759	"RTN","BPS RES",153,0 )
10760	;Check fo r "^" or t imeout
10761	"RTN","BPS RES",154,0 )
10762	I ($D(DUO UT))!($D(D TOUT)) S B PQ=-1 K X, DIC,Y G XP ROMPTS
10763	"RTN","BPS RES",155,0 )
10764	S BPRELCD =$P(Y,U,2)
10765	"RTN","BPS RES",156,0 )
10766	K X,DIC,Y
10767	"RTN","BPS RES",157,0 )
10768	;
10769	"RTN","BPS RES",158,0 )
10770	;Person C ode
10771	"RTN","BPS RES",159,0 )
10772	K DIR("?" ) S DIR(0) ="FO^1:3", DIR("A")=" Pharmacy P erson Code ",DIR("?") ="Enter th e Specific Person Co de Assigne d to the P atient by the Payer"
10773	"RTN","BPS RES",160,0 )
10774	S DIR("B" )=BPPSNCD
10775	"RTN","BPS RES",161,0 )
10776	D ^DIR
10777	"RTN","BPS RES",162,0 )
10778	I $D(DTOU T)!$D(DUOU T) S BPQ=- 1 G XPROMP TS
10779	"RTN","BPS RES",163,0 )
10780	S BPPSNCD =Y
10781	"RTN","BPS RES",164,0 )
10782	;
10783	"RTN","BPS RES",165,0 )
10784	;Pre-Auth orization
10785	"RTN","BPS RES",166,0 )
10786	K DIR("?" ) S DIR(0) ="FO^1:11" ,DIR("A")= "Prior Aut horization Number",D IR("?")="E nter the N umber Subm itted by t he Provide r to Ident ify the Pr ior Author ization"
10787	"RTN","BPS RES",167,0 )
10788	S DIR("B" )=BPPREAUT
10789	"RTN","BPS RES",168,0 )
10790	D ^DIR
10791	"RTN","BPS RES",169,0 )
10792	I $D(DTOU T)!$D(DUOU T) S BPQ=- 1 G XPROMP TS
10793	"RTN","BPS RES",170,0 )
10794	S BPPREAU T=Y
10795	"RTN","BPS RES",171,0 )
10796	;
10797	"RTN","BPS RES",172,0 )
10798	;Prior-Au thorizatio n Type Cod e
10799	"RTN","BPS RES",173,0 )
10800	N X,DIC,Y
10801	"RTN","BPS RES",174,0 )
10802	S DIC("B" )=+BPPRETY P
10803	"RTN","BPS RES",175,0 )
10804	S DIC(0)= "QEAM",DIC =9002313.2 6,DIC("A") ="Prior Au thorizatio n Type Cod e: "
10805	"RTN","BPS RES",176,0 )
10806	D ^DIC
10807	"RTN","BPS RES",177,0 )
10808	;Check fo r "^" or t imeout
10809	"RTN","BPS RES",178,0 )
10810	I ($D(DUO UT))!($D(D TOUT)) S B PQ=-1 K X, DIC,Y G XP ROMPTS
10811	"RTN","BPS RES",179,0 )
10812	S BPPRETY P=$P(Y,U,2 )
10813	"RTN","BPS RES",180,0 )
10814	K X,DIC,Y
10815	"RTN","BPS RES",181,0 )
10816	;
10817	"RTN","BPS RES",182,0 )
10818	; If ther e is a pen ding rejec t on the P harmacists Worklist, or there
10819	"RTN","BPS RES",183,0 )
10820	; is a re solved or unresolved reject 79 or 88, th en only di splay
10821	"RTN","BPS RES",184,0 )
10822	; Submiss ion Clarif ication Co des and do not allow enter/edi t. (BPS1 21)
10823	"RTN","BPS RES",185,0 )
10824	;
10825	"RTN","BPS RES",186,0 )
10826	I $$BPSKI P(BPRXIEN, BPRXR) D G P1
10827	"RTN","BPS RES",187,0 )
10828	. F BP354 01=1:1:3 I @("BPCLCD "_BP35401) D
10829	"RTN","BPS RES",188,0 )
10830	. . S BPS X=+@("BPCL CD"_BP3540 1)
10831	"RTN","BPS RES",189,0 )
10832	. . W !," Submission Clarifica tion Code ",BP35401, ": ",BPSX
10833	"RTN","BPS RES",190,0 )
10834	. . S BPC LCDX=$O(^B PS(9002313 .25,"B",BP SX,"")),BP CLCDN=$P(^ BPS(900231 3.25,BPCLC DX,0),U,2)
10835	"RTN","BPS RES",191,0 )
10836	. . W ?44 ,BPCLCDN
10837	"RTN","BPS RES",192,0 )
10838	. . Q
10839	"RTN","BPS RES",193,0 )
10840	. W !," * *OPECC can not edit S ub. Clar. Code field for this reject - r efer to Ph armacist"
10841	"RTN","BPS RES",194,0 )
10842	. Q
10843	"RTN","BPS RES",195,0 )
10844	;
10845	"RTN","BPS RES",196,0 )
10846	;Submissi on Clarifi cation Cod e 1
10847	"RTN","BPS RES",197,0 )
10848	S DIC("B" )=BPCLCD1
10849	"RTN","BPS RES",198,0 )
10850	S DIC(0)= "QEAM",DIC =9002313.2 5,DIC("A") ="Submissi on Clarifi cation Cod e 1: "
10851	"RTN","BPS RES",199,0 )
10852	D ^DIC
10853	"RTN","BPS RES",200,0 )
10854	;Check fo r "^" or t imeout
10855	"RTN","BPS RES",201,0 )
10856	I ($D(DUO UT))!($D(D TOUT)) S B PQ=-1 K X, DIC,Y G XP ROMPTS
10857	"RTN","BPS RES",202,0 )
10858	S BPCLCD1 =$P(Y,U,2)
10859	"RTN","BPS RES",203,0 )
10860	K X,DIC,Y
10861	"RTN","BPS RES",204,0 )
10862	;
10863	"RTN","BPS RES",205,0 )
10864	;Submissi on Clarifi cation Cod e 2
10865	"RTN","BPS RES",206,0 )
10866	I +BPCLCD 2 S BPCLCD 2=+BPCLCD2 S DIC("B" )=BPCLCD2
10867	"RTN","BPS RES",207,0 )
10868	S DIC(0)= "QEAM",DIC =9002313.2 5,DIC("A") ="Submissi on Clarifi cation Cod e 2: ",DUP =0
10869	"RTN","BPS RES",208,0 )
10870	F D Q:B PQ=-1 Q:' DUP
10871	"RTN","BPS RES",209,0 )
10872	. D ^DIC
10873	"RTN","BPS RES",210,0 )
10874	. ;Check for "^" or timeout
10875	"RTN","BPS RES",211,0 )
10876	. I ($D(D UOUT))!($D (DTOUT)) S BPQ=-1 K X,DIC,Y Q
10877	"RTN","BPS RES",212,0 )
10878	. S BPCLC D2=$P(Y,U, 2)
10879	"RTN","BPS RES",213,0 )
10880	. S DUP=0 I BPCLCD2 =BPCLCD1 S BPCLCD2=" " W !," D uplicates not allowe d" S DUP=1
10881	"RTN","BPS RES",214,0 )
10882	K X,DIC,Y
10883	"RTN","BPS RES",215,0 )
10884	I BPQ=-1 G XPROMPTS
10885	"RTN","BPS RES",216,0 )
10886	;
10887	"RTN","BPS RES",217,0 )
10888	;Submissi on Clarifi cation Cod e 3
10889	"RTN","BPS RES",218,0 )
10890	I BPCLCD2 '="" D I BPQ=-1 G X PROMPTS
10891	"RTN","BPS RES",219,0 )
10892	. I +BPCL CD3 S BPCL CD3=+BPCLC D3 S DIC(" B")=BPCLCD 3
10893	"RTN","BPS RES",220,0 )
10894	. S DIC(0 )="QEAM",D IC=9002313 .25,DIC("A ")="Submis sion Clari fication C ode 3: ",D UP=0
10895	"RTN","BPS RES",221,0 )
10896	. F D Q :'DUP I B PQ=-1 Q
10897	"RTN","BPS RES",222,0 )
10898	. . D ^DI C
10899	"RTN","BPS RES",223,0 )
10900	. . ;Chec k for "^" or timeout
10901	"RTN","BPS RES",224,0 )
10902	. . I ($D (DUOUT))!( $D(DTOUT)) S BPQ=-1 K X,DIC,Y Q
10903	"RTN","BPS RES",225,0 )
10904	. . S BPC LCD3=$P(Y, U,2)
10905	"RTN","BPS RES",226,0 )
10906	. . S DUP =0 I BPCLC D3=BPCLCD1 !(BPCLCD3= BPCLCD2) S BPCLCD3=" " W !," D uplicates not allowe d" S DUP=1
10907	"RTN","BPS RES",227,0 )
10908	. K X,DIC ,Y
10909	"RTN","BPS RES",228,0 )
10910	;
10911	"RTN","BPS RES",229,0 )
10912	P1 ;
10913	"RTN","BPS RES",230,0 )
10914	;
10915	"RTN","BPS RES",231,0 )
10916	I $$RELDA TE^BPSBCKJ (+BPRXIEN, +BPRXR)]"" S BPDOSDT =$$EDITDT( 1,BPRXIEN, BPRXR,BP02 ) I BPDOSD T="^" S BP Q=-1 G XPR OMPTS
10917	"RTN","BPS RES",232,0 )
10918	;
10919	"RTN","BPS RES",233,0 )
10920	;Patient Residence Code
10921	"RTN","BPS RES",234,0 )
10922	N X,DIC,Y
10923	"RTN","BPS RES",235,0 )
10924	S DIC("B" )=+BPPTRES
10925	"RTN","BPS RES",236,0 )
10926	S DIC(0)= "QEAM",DIC =9002313.2 7,DIC("A") ="Patient Residence Code: "
10927	"RTN","BPS RES",237,0 )
10928	D ^DIC
10929	"RTN","BPS RES",238,0 )
10930	;Check fo r "^" or t imeout
10931	"RTN","BPS RES",239,0 )
10932	I ($D(DUO UT))!($D(D TOUT)) S B PQ=-1 K X, DIC,Y G XP ROMPTS
10933	"RTN","BPS RES",240,0 )
10934	S BPPTRES =$P(Y,U,2)
10935	"RTN","BPS RES",241,0 )
10936	K X,DIC,Y
10937	"RTN","BPS RES",242,0 )
10938	;
10939	"RTN","BPS RES",243,0 )
10940	;Pharmacy Service T ype Code
10941	"RTN","BPS RES",244,0 )
10942	N X,DIC,Y
10943	"RTN","BPS RES",245,0 )
10944	S DIC("B" )=+BPPHSRV
10945	"RTN","BPS RES",246,0 )
10946	S DIC(0)= "QEAM",DIC =9002313.2 8,DIC("A") ="Pharmacy Service T ype Code: "
10947	"RTN","BPS RES",247,0 )
10948	D ^DIC
10949	"RTN","BPS RES",248,0 )
10950	;Check fo r "^" or t imeout
10951	"RTN","BPS RES",249,0 )
10952	I ($D(DUO UT))!($D(D TOUT)) S B PQ=-1 K X, DIC,Y G XP ROMPTS
10953	"RTN","BPS RES",250,0 )
10954	S BPPHSRV =$P(Y,U,2)
10955	"RTN","BPS RES",251,0 )
10956	K X,DIC,Y
10957	"RTN","BPS RES",252,0 )
10958	;
10959	"RTN","BPS RES",253,0 )
10960	;Delay Re ason Code
10961	"RTN","BPS RES",254,0 )
10962	N X,DIC,Y
10963	"RTN","BPS RES",255,0 )
10964	S DIC("B" )=BPDLYRS
10965	"RTN","BPS RES",256,0 )
10966	S DIC(0)= "QEAM",DIC =9002313.2 9,DIC("A") ="Delay Re ason Code: "
10967	"RTN","BPS RES",257,0 )
10968	D ^DIC
10969	"RTN","BPS RES",258,0 )
10970	;Check fo r "^" or t imeout
10971	"RTN","BPS RES",259,0 )
10972	I ($D(DUO UT))!($D(D TOUT)) S B PQ=-1 K X, DIC,Y G XP ROMPTS
10973	"RTN","BPS RES",260,0 )
10974	S BPDLYRS =$P(Y,U,2)
10975	"RTN","BPS RES",261,0 )
10976	K X,DIC,Y
10977	"RTN","BPS RES",262,0 )
10978	;
10979	"RTN","BPS RES",263,0 )
10980	; If seco ndary clai m, setup s econdary d ata and al low user t o edit
10981	"RTN","BPS RES",264,0 )
10982	; Get dat a from the primary c laim, if i t exists
10983	"RTN","BPS RES",265,0 )
10984	I BPCOB=2 D I BPQ= -1 G XPROM PTS
10985	"RTN","BPS RES",266,0 )
10986	. N BPSPL 59,BPRTTP5 9
10987	"RTN","BPS RES",267,0 )
10988	. S BPRET =$$PRIMDAT A^BPSPRRX6 (BPRXIEN,B PRXR,.BPSE COND)
10989	"RTN","BPS RES",268,0 )
10990	. ; If th e primary claim data is missin g, get dat a from the most rece nt seconda ry claim
10991	"RTN","BPS RES",269,0 )
10992	. I 'BPRE T,$$SECDAT A^BPSPRRX6 (BPRXIEN,B PRXR,.BPSP L59,.BPSEC OND,.BPRTT P59)
10993	"RTN","BPS RES",270,0 )
10994	. ; The P RIMARY BIL L element is set by $$SECDATA. If SECDA TA is not called, th is element will be
10995	"RTN","BPS RES",271,0 )
10996	. ; mis sing and w e will nee d to creat e it
10997	"RTN","BPS RES",272,0 )
10998	. I '$D(B PSECOND("P RIMARY BIL L")) D
10999	"RTN","BPS RES",273,0 )
11000	.. N BPBI LL
11001	"RTN","BPS RES",274,0 )
11002	.. S BPBI LL=$$PAYBL PRI^BPSUTI L2(BP59)
11003	"RTN","BPS RES",275,0 )
11004	.. I BPBI LL>0 S BPS ECOND("PRI MARY BILL" )=BPBILL
11005	"RTN","BPS RES",276,0 )
11006	. ; Set f lag tellin g BPSNCPDP not to re compile th e data fro m the BPS Transactio n and the secondary claim
11007	"RTN","BPS RES",277,0 )
11008	. S BPSEC OND("NEW C OB DATA")= 1
11009	"RTN","BPS RES",278,0 )
11010	. ; $$PRO MPTS displ ays the da ta and all ows the us er edit th e data.
11011	"RTN","BPS RES",279,0 )
11012	. S BPQ=$ $PROMPTS^B PSPRRX3(BP RXIEN,BPRX R,BPDOSDT, .BPSECOND)
11013	"RTN","BPS RES",280,0 )
11014	;
11015	"RTN","BPS RES",281,0 )
11016	;Ask to p roceed
11017	"RTN","BPS RES",282,0 )
11018	W ! S BPQ =$$YESNO^B PSSCRRS("A re you sur e?(Y/N)") I BPQ'=1 S BPQ=-1 G XPROMPTS
11019	"RTN","BPS RES",283,0 )
11020	S BPQ=1
11021	"RTN","BPS RES",284,0 )
11022	;
11023	"RTN","BPS RES",285,0 )
11024	;Save int o BPS NCPD P OVERRIDE S (#900231 3.511)
11025	"RTN","BPS RES",286,0 )
11026	S BPFDA(9 002313.511 ,"+1,",.01 )=BP59
11027	"RTN","BPS RES",287,0 )
11028	D NOW^%DT C
11029	"RTN","BPS RES",288,0 )
11030	S BPFDA(9 002313.511 ,"+1,",.02 )=%
11031	"RTN","BPS RES",289,0 )
11032	S BPFLD=$ O(^BPSF(90 02313.91," B",303,"") ) I BPFLD] "" S BPFDA (9002313.5 111,"+2,+1 ,",.01)=BP FLD,BPFDA( 9002313.51 11,"+2,+1, ",.02)=BPP SNCD
11033	"RTN","BPS RES",290,0 )
11034	S BPFLD=$ O(^BPSF(90 02313.91," B",306,"") ) I BPFLD] "" S BPFDA (9002313.5 111,"+3,+1 ,",.01)=BP FLD,BPFDA( 9002313.51 11,"+3,+1, ",.02)=BPR ELCD
11035	"RTN","BPS RES",291,0 )
11036	S BPFLD=$ O(^BPSF(90 02313.91," B",462,"") ) I BPFLD] "" S BPFDA (9002313.5 111,"+4,+1 ,",.01)=BP FLD,BPFDA( 9002313.51 11,"+4,+1, ",.02)=BPP REAUT
11037	"RTN","BPS RES",292,0 )
11038	S BPFLD=$ O(^BPSF(90 02313.91," B",461,"") ) I BPFLD] "" S BPFDA (9002313.5 111,"+5,+1 ,",.01)=BP FLD,BPFDA( 9002313.51 11,"+5,+1, ",.02)=BPP RETYP
11039	"RTN","BPS RES",293,0 )
11040	S BPFLD=$ O(^BPSF(90 02313.91," B",420,"") ) I BPFLD] "" S BPFDA (9002313.5 111,"+6,+1 ,",.01)=BP FLD,BPFDA( 9002313.51 11,"+6,+1, ",.02)=BPC LCD1_"~"_$ G(BPCLCD2) _"~"_$G(BP CLCD3)
11041	"RTN","BPS RES",294,0 )
11042	S BPFLD=$ O(^BPSF(90 02313.91," B",384,"") ) I BPFLD] "" S BPFDA (9002313.5 111,"+7,+1 ,",.01)=BP FLD,BPFDA( 9002313.51 11,"+7,+1, ",.02)=BPP TRES
11043	"RTN","BPS RES",295,0 )
11044	S BPFLD=$ O(^BPSF(90 02313.91," B",147,"") ) I BPFLD] "" S BPFDA (9002313.5 111,"+8,+1 ,",.01)=BP FLD,BPFDA( 9002313.51 11,"+8,+1, ",.02)=BPP HSRV
11045	"RTN","BPS RES",296,0 )
11046	S BPFLD=$ O(^BPSF(90 02313.91," B",357,"") ) I BPFLD] "" S BPFDA (9002313.5 111,"+9,+1 ,",.01)=BP FLD,BPFDA( 9002313.51 11,"+9,+1, ",.02)=BPD LYRS
11047	"RTN","BPS RES",297,0 )
11048	D UPDATE^ DIE("","BP FDA","BPOV RIEN","BPM SG")
11049	"RTN","BPS RES",298,0 )
11050	;
11051	"RTN","BPS RES",299,0 )
11052	I $D(BPMS G("DIERR") ) W !!,"Co uld Not Sa ve Overrid e informat ion into B PS NCPDP O VERRIDES F ILES",! S BPQ=-1 G X PROMPTS
11053	"RTN","BPS RES",300,0 )
11054	;
11055	"RTN","BPS RES",301,0 )
11056	XPROMPTS ;
11057	"RTN","BPS RES",302,0 )
11058	S BPOVRIE N=$S(BPQ=- 1:BPQ,$G(B POVRIEN(1) )]"":BPOVR IEN(1),1:- 1)
11059	"RTN","BPS RES",303,0 )
11060	Q BPOVRIE N
11061	"RTN","BPS RES",304,0 )
11062	;
11063	"RTN","BPS RES",305,0 )
11064	;Prompt U ser for Cl aim to Res ubmit (w/E DITS)
11065	"RTN","BPS RES",306,0 )
11066	;
11067	"RTN","BPS RES",307,0 )
11068	; Input v alues -> BPROMPT - prompt str ing
11069	"RTN","BPS RES",308,0 )
11070	; B PERRMES - the messag e to displ ay when th e user tri es
11071	"RTN","BPS RES",309,0 )
11072	; t o make mul ti line se lection (o ptional)
11073	"RTN","BPS RES",310,0 )
11074	; Piece
11075	"RTN","BPS RES",311,0 )
11076	;output v alues -> 1 - 1 = okay, <0 = errors, 0 = quit
11077	"RTN","BPS RES",312,0 )
11078	; 2 - pa tient ien #2
11079	"RTN","BPS RES",313,0 )
11080	; 3 - in surance ie n #36
11081	"RTN","BPS RES",314,0 )
11082	; 4 - pt r to #9002 313.59
11083	"RTN","BPS RES",315,0 )
11084	; 5 - 1s t line for index(es) in LM "VA LM" array
11085	"RTN","BPS RES",316,0 )
11086	; 6 - pa tient's in dex
11087	"RTN","BPS RES",317,0 )
11088	; 7 - cl aim's inde x
11089	"RTN","BPS RES",318,0 )
11090	ASKLINE(BP ROMPT,BPER RMES) ;
11091	"RTN","BPS RES",319,0 )
11092	N BPRET,B PCNT
11093	"RTN","BPS RES",320,0 )
11094	S BPRET=" ",BPCNT=0
11095	"RTN","BPS RES",321,0 )
11096	F S BPRE T=$$SELLIN E^BPSSCRU4 (BPROMPT," C",VALMAR, "") Q:BPRE T'<0 D
11097	"RTN","BPS RES",322,0 )
11098	. ;
11099	"RTN","BPS RES",323,0 )
11100	. I BPCNT <1 S BPCNT =BPCNT+1 W !
11101	"RTN","BPS RES",324,0 )
11102	. E S BP CNT=0 D RE ^VALM4
11103	"RTN","BPS RES",325,0 )
11104	. I BPRET =-1 W "Inv alid line number" ; (invalid P atient sum mary line) "
11105	"RTN","BPS RES",326,0 )
11106	. I BPRET =-8 W $S($ G(BPERRMES )]"":BPERR MES,1:" In valid line number")
11107	"RTN","BPS RES",327,0 )
11108	. I BPRET =-4 W "Inv alid line number" ; (invalid R X line)"
11109	"RTN","BPS RES",328,0 )
11110	. I BPRET =-2 W "Ple ase select Patient's summary l ine."
11111	"RTN","BPS RES",329,0 )
11112	. I BPRET =-3 W "Ple ase specif y RX line. "
11113	"RTN","BPS RES",330,0 )
11114	. I ",-1, -8,-4,-2,- 3,"'[(","_ BPRET_",") W "Incorr ect format ." ; Corru pted array (",BPRET, ")"
11115	"RTN","BPS RES",331,0 )
11116	Q BPRET
11117	"RTN","BPS RES",332,0 )
11118	;
11119	"RTN","BPS RES",333,0 )
11120	EDITDT(DFL T,BPRXIEN, BPRXR,BP02 ) ;Prompt User to ch oose corre ct Date of Service
11121	"RTN","BPS RES",334,0 )
11122	;
11123	"RTN","BPS RES",335,0 )
11124	; Input v alue -> D FLT - The data to us e as the d efault val ue. If no default
11125	"RTN","BPS RES",336,0 )
11126	; is p rovided, C urrent Dat e of Servi ce will be used.
11127	"RTN","BPS RES",337,0 )
11128	;
11129	"RTN","BPS RES",338,0 )
11130	; 1 - Current Da te of Serv ice
11131	"RTN","BPS RES",339,0 )
11132	; 2 - Fill Date
11133	"RTN","BPS RES",340,0 )
11134	; 3 - Release Da te
11135	"RTN","BPS RES",341,0 )
11136	;
11137	"RTN","BPS RES",342,0 )
11138	; BPRX IEN - Poin ter to the PRESCRIPT ION file ( #52)
11139	"RTN","BPS RES",343,0 )
11140	; BP RXR - Refi ll number for prescr iption
11141	"RTN","BPS RES",344,0 )
11142	; B P02 - Poin ter to the BPS CLAIM S file (#9 002313.02)
11143	"RTN","BPS RES",345,0 )
11144	;
11145	"RTN","BPS RES",346,0 )
11146	; Output value -> S elected Da te of Serv ice in Fil eMan forma t
11147	"RTN","BPS RES",347,0 )
11148	;
11149	"RTN","BPS RES",348,0 )
11150	; Referen ce to $$RX RLDT^PSOBP SUT suppor ted by DBI A 4701
11151	"RTN","BPS RES",349,0 )
11152	; Referen ce to $$RX FLDT^PSOBP SUT suppor ted by DBI A 4701
11153	"RTN","BPS RES",350,0 )
11154	;
11155	"RTN","BPS RES",351,0 )
11156	N BPRLS,B PFIL,BPCUR ,DIR,DIRUT ,DIROUT,DT OUT,DUOUT, OPT,TMP,X, Y
11157	"RTN","BPS RES",352,0 )
11158	S BPRLS=$ $RXRLDT^PS OBPSUT(BPR XIEN,BPRXR )\1 ;relea se date
11159	"RTN","BPS RES",353,0 )
11160	S BPFIL=$ $RXFLDT^PS OBPSUT(BPR XIEN,BPRXR )\1 ;fill date
11161	"RTN","BPS RES",354,0 )
11162	S BPCUR=$ $HL7TFM^XL FDT($$GET1 ^DIQ(90023 13.02,BP02 ,401)) ;cu rrent date of servic e
11163	"RTN","BPS RES",355,0 )
11164	S DFLT=$G (DFLT),DIR ("B")=1,DI R("A")="Da te of Serv ice"
11165	"RTN","BPS RES",356,0 )
11166	I DFLT=2, BPFIL]"" S DIR("B")= 2
11167	"RTN","BPS RES",357,0 )
11168	I DFLT=3, BPRLS]"" S DIR("B")= 3
11169	"RTN","BPS RES",358,0 )
11170	S OPT=1,D IR(0)="S^" _OPT_":"_$ $FMTE^XLFD T(BPCUR,"5 D")_" Curr ent Date o f Service" ,TMP(OPT)= BPCUR
11171	"RTN","BPS RES",359,0 )
11172	I BPFIL'> DT,BPFIL<B PRLS S OPT =OPT+1,DIR (0)=DIR(0) _";"_OPT_" :"_$$FMTE^ XLFDT(BPFI L,"5D")_" Fill Date" ,TMP(OPT)= BPFIL
11173	"RTN","BPS RES",360,0 )
11174	I BPRLS'> DT S OPT=O PT+1,DIR(0 )=DIR(0)_" ;"_OPT_":" _$$FMTE^XL FDT(BPRLS, "5D")_" Re lease Date ",TMP(OPT) =BPRLS
11175	"RTN","BPS RES",361,0 )
11176	D ^DIR
11177	"RTN","BPS RES",362,0 )
11178	I $D(DIRU T) S Y="^" Q Y
11179	"RTN","BPS RES",363,0 )
11180	Q TMP(Y)
11181	"RTN","BPS RES",364,0 )
11182	;
11183	"RTN","BPS RES",365,0 )
11184	BPSKIP(BPS RX,BPSFILL ) ; Determ ine whethe r to skip the enter/ edit of Su bmission C larificati on Codes
11185	"RTN","BPS RES",366,0 )
11186	; This fu nction wil l return a '1' if th e enter/ed it of Subm ission
11187	"RTN","BPS RES",367,0 )
11188	; Clarifi cation Cod es should be skipped (not allo wed).
11189	"RTN","BPS RES",368,0 )
11190	;
11191	"RTN","BPS RES",369,0 )
11192	N BPS7988 DATE,BPSAC TIVITY,BPS ECMEDATE,B PSREJECT,B PSX
11193	"RTN","BPS RES",370,0 )
11194	;
11195	"RTN","BPS RES",371,0 )
11196	; If any open/unres olved reje cts are on the pharm acist work list, Quit with 1.
11197	"RTN","BPS RES",372,0 )
11198	;
11199	"RTN","BPS RES",373,0 )
11200	I $$FIND^ PSOREJUT(B PSRX,BPSFI LL) Q 1
11201	"RTN","BPS RES",374,0 )
11202	;
11203	"RTN","BPS RES",375,0 )
11204	; If ther e are any closed/res olved 79/8 8 rejects for this R x/Fill,
11205	"RTN","BPS RES",376,0 )
11206	; pull th e latest d etected da te/time.
11207	"RTN","BPS RES",377,0 )
11208	; If ther e has not been any E CME activi ty since t hat date/t ime, then
11209	"RTN","BPS RES",378,0 )
11210	; disallo w the edit of Submis sion Clari fication C odes, Quit with 1.
11211	"RTN","BPS RES",379,0 )
11212	;
11213	"RTN","BPS RES",380,0 )
11214	S BPS7988 DATE=0
11215	"RTN","BPS RES",381,0 )
11216	;
11217	"RTN","BPS RES",382,0 )
11218	; Loop th rough the REJECTS mu ltiple.
11219	"RTN","BPS RES",383,0 )
11220	S BPSREJE CT=0
11221	"RTN","BPS RES",384,0 )
11222	F S BPSR EJECT=$O(^ PSRX(BPSRX ,"REJ",BPS REJECT)) Q :'BPSREJEC T D
11223	"RTN","BPS RES",385,0 )
11224	. ; If a reject is not for th e current fill, skip this one.
11225	"RTN","BPS RES",386,0 )
11226	. I $$GET 1^DIQ(52.2 5,BPSREJEC T_","_BPSR X,5)'=BPSF ILL Q
11227	"RTN","BPS RES",387,0 )
11228	. ;
11229	"RTN","BPS RES",388,0 )
11230	. ; If no t a 79 or 88, skip t his one.
11231	"RTN","BPS RES",389,0 )
11232	. I ",79, 88,"'[("," _$$GET1^DI Q(52.25,BP SREJECT_", "_BPSRX,.0 1)_",") Q
11233	"RTN","BPS RES",390,0 )
11234	. ;
11235	"RTN","BPS RES",391,0 )
11236	. ; Pull DATE/TIME DETECTED. If the da te/time is later tha n
11237	"RTN","BPS RES",392,0 )
11238	. ; BPS79 88DATE, th en reset B PS7988DATE to that d ate/time.
11239	"RTN","BPS RES",393,0 )
11240	. S BPSX= $$GET1^DIQ (52.25,BPS REJECT_"," _BPSRX,1," I")
11241	"RTN","BPS RES",394,0 )
11242	. I BPSX> BPS7988DAT E S BPS798 8DATE=BPSX
11243	"RTN","BPS RES",395,0 )
11244	. Q
11245	"RTN","BPS RES",396,0 )
11246	;
11247	"RTN","BPS RES",397,0 )
11248	; If <bla nk> then Q uit with 0 .
11249	"RTN","BPS RES",398,0 )
11250	I BPS7988 DATE=0 Q 0
11251	"RTN","BPS RES",399,0 )
11252	;
11253	"RTN","BPS RES",400,0 )
11254	; Once we have the most recen t DATE/TIM E DETECTED , determin e whether
11255	"RTN","BPS RES",401,0 )
11256	; there i s ECME act ivity late r than tha t.
11257	"RTN","BPS RES",402,0 )
11258	;
11259	"RTN","BPS RES",403,0 )
11260	; Loop th rough entr ies the AC TIVITY LOG multiple.
11261	"RTN","BPS RES",404,0 )
11262	S (BPSX,B PSACTIVITY ,BPSECMEDA TE)=0
11263	"RTN","BPS RES",405,0 )
11264	F S BPSA CTIVITY=$O (^PSRX(BPS RX,"A",BPS ACTIVITY)) Q:'BPSACT IVITY D
11265	"RTN","BPS RES",406,0 )
11266	. ; If th e REASON i s not "M" (=ECME), s kip.
11267	"RTN","BPS RES",407,0 )
11268	. I $$GET 1^DIQ(52.3 ,BPSACTIVI TY_","_BPS RX,.02,"I" )'="M" Q
11269	"RTN","BPS RES",408,0 )
11270	. ;
11271	"RTN","BPS RES",409,0 )
11272	. ; Pull the date/t ime stamp from the a ctivity lo g entry. If later
11273	"RTN","BPS RES",410,0 )
11274	. ; than what we fo und so far , update B PSECMEDATE .
11275	"RTN","BPS RES",411,0 )
11276	. S BPSX= $$GET1^DIQ (52.3,BPSA CTIVITY_", "_BPSRX,.0 1,"I")
11277	"RTN","BPS RES",412,0 )
11278	. I BPSX> BPSECMEDAT E S BPSECM EDATE=BPSX
11279	"RTN","BPS RES",413,0 )
11280	. Q
11281	"RTN","BPS RES",414,0 )
11282	;
11283	"RTN","BPS RES",415,0 )
11284	; If the BPSECMEDAT E is later than BPS7 988DATE, t hen Quit w ith 0
11285	"RTN","BPS RES",416,0 )
11286	; to allo w the edit of Submis sion Clari fication C odes. Oth erwise,
11287	"RTN","BPS RES",417,0 )
11288	; Quit wi th 1 to sk ip, not al low, the e nter/edit of those c odes.
11289	"RTN","BPS RES",418,0 )
11290	; When a claim is r ejected, t he time st amp on the Activity Log may
11291	"RTN","BPS RES",419,0 )
11292	; be a se cond or tw o later th an the tim e stamp on the Rejec t.
11293	"RTN","BPS RES",420,0 )
11294	; Therefo re, we add 60 second s to the t ime stamp on the rej ect when
11295	"RTN","BPS RES",421,0 )
11296	; making this compa rison.
11297	"RTN","BPS RES",422,0 )
11298	;
11299	"RTN","BPS RES",423,0 )
11300	I BPSECME DATE>(BPS7 988DATE+.0 0006) Q 0
11301	"RTN","BPS RES",424,0 )
11302	Q 1
11303	"RTN","BPS RES",425,0 )
11304	;
11305	"RTN","BPS SCRU3")
11306	0^3^B44461 073^B43064 796
11307	"RTN","BPS SCRU3",1,0 )
11308	BPSSCRU3 ; BHAM ISC/S S - ECME S CREEN UTIL ITIES ;05- APR-05
11309	"RTN","BPS SCRU3",2,0 )
11310	;;1.0;E C LAIMS MGMT ENGINE; 1,5,7,8,9, 10,20,21 ;JUN 2004; Build 28
11311	"RTN","BPS SCRU3",3,0 )
11312	;;Per VA Directive 6402, this routine s hould not be modifie d.
11313	"RTN","BPS SCRU3",4,0 )
11314	;USER SCR EEN
11315	"RTN","BPS SCRU3",5,0 )
11316	Q
11317	"RTN","BPS SCRU3",6,0 )
11318	;get comm ent from B PS TRANSAC TION file
11319	"RTN","BPS SCRU3",7,0 )
11320	;BP59 - i en in that file
11321	"RTN","BPS SCRU3",8,0 )
11322	COMMENT(BP 59) ;
11323	"RTN","BPS SCRU3",9,0 )
11324	N BPCMNT, BPX,BPTXT
11325	"RTN","BPS SCRU3",10, 0)
11326	S BPCMNT= $O(^BPST(B P59,11,999 999),-1)
11327	"RTN","BPS SCRU3",11, 0)
11328	I BPCMNT= "" Q ""
11329	"RTN","BPS SCRU3",12, 0)
11330	S BPX=$G( ^BPST(BP59 ,11,BPCMNT ,0))
11331	"RTN","BPS SCRU3",13, 0)
11332	; If the date/time of the com ment is ea rlier than the date/ time of
11333	"RTN","BPS SCRU3",14, 0)
11334	; the Sub mit Date, then do no t display the commen t (BPS12 1)
11335	"RTN","BPS SCRU3",15, 0)
11336	I $P(BPX, U,1)<$P($G (^BPST(BP5 9,0)),U,7) Q "Prior comments s uppressed- use CMT ac tion for a ll comment s"
11337	"RTN","BPS SCRU3",16, 0)
11338	S BPTXT=$ P(BPX,U,3) I $L(BPTX T)>60 S BP TXT=$S(+$P (BPX,U,4): $E(BPTXT,1 ,50)_"..." ,1:$E(BPTX T,1,58)_". ..")
11339	"RTN","BPS SCRU3",17, 0)
11340	Q $$DATTI M($P(BPX,U ,1)\1)_$S( +$P(BPX,U, 4):" (Phar m)",1:"")_ " - "_BPTX T_U_$$USER NAM^BPSCMT 01($P(BPX, U,2))
11341	"RTN","BPS SCRU3",18, 0)
11342	;
11343	"RTN","BPS SCRU3",19, 0)
11344	DATTIM(X) ;Convert F M date to displayabl e (mm/dd/y y HH:MM) f ormat.
11345	"RTN","BPS SCRU3",20, 0)
11346	I +X=0 W ""
11347	"RTN","BPS SCRU3",21, 0)
11348	N DATE,YR ,BPT,BPM,B PH,BPAP
11349	"RTN","BPS SCRU3",22, 0)
11350	I $G(X) S YR=$E(X,2 ,3)
11351	"RTN","BPS SCRU3",23, 0)
11352	I $G(X) S DATE=$S(X :$E(X,4,5) _"/"_$E(X, 6,7)_"/"_Y R,1:"")
11353	"RTN","BPS SCRU3",24, 0)
11354	S BPT=$P( X,".",2) S :$L(BPT)<4 BPT=BPT_$ E("0000",1 ,4-$L(BPT) )
11355	"RTN","BPS SCRU3",25, 0)
11356	S BPH=$E( BPT,1,2),B PM=$E(BPT, 3,4)
11357	"RTN","BPS SCRU3",26, 0)
11358	S BPAP="a " I BPH>12 S BPH=BPH -12,BPAP=" p" S:$L(BP H)<2 BPH=" 0"_BPH
11359	"RTN","BPS SCRU3",27, 0)
11360	I BPT S:' BPH BPH=12 S DATE=DA TE_" "_BPH _":"_BPM_B PAP
11361	"RTN","BPS SCRU3",28, 0)
11362	Q $G(DATE )
11363	"RTN","BPS SCRU3",29, 0)
11364	;/**
11365	"RTN","BPS SCRU3",30, 0)
11366	;a wrappe r for $$ST ATUS^BPSOS RX to get the status by BPS TR ANSACTION pointer
11367	"RTN","BPS SCRU3",31, 0)
11368	;input BP 59 - ptr t o 9002313. 59
11369	"RTN","BPS SCRU3",32, 0)
11370	;output - pieces 1, 2 and 3 of the $$STA TUS^BPSOSR X output
11371	"RTN","BPS SCRU3",33, 0)
11372	; example : "E REVER SAL ACCEPT ED^3071206 .152829^Re versal Acc epted"
11373	"RTN","BPS SCRU3",34, 0)
11374	CLAIMST(BP 59) ;*/
11375	"RTN","BPS SCRU3",35, 0)
11376	N BPX,BPS TATUS,BPRE F,BPSCHED
11377	"RTN","BPS SCRU3",36, 0)
11378	N BPCOB S BPCOB=$$C OB59^BPSUT IL2(BP59)
11379	"RTN","BPS SCRU3",37, 0)
11380	S BPSCHED =0
11381	"RTN","BPS SCRU3",38, 0)
11382	S BPX=$$R XREF^BPSSC RU2(BP59)
11383	"RTN","BPS SCRU3",39, 0)
11384	S BPREF=$ P(BPX,U,2)
11385	"RTN","BPS SCRU3",40, 0)
11386	S BPSTATU S=$$STATUS ^BPSOSRX(+ BPX,BPREF, ,,BPCOB)
11387	"RTN","BPS SCRU3",41, 0)
11388	;if the r equest com pleted (99 %) and the re is anot her active (schedule d, activat ed,
11389	"RTN","BPS SCRU3",42, 0)
11390	;in proce ss,complet ed but not inactivat ed yet) re quest then return IN PROGRESS
11391	"RTN","BPS SCRU3",43, 0)
11392	I $P(BPST ATUS,U,4)= 99,$$ACTRE QS^BPSOSRX 6(+BPX,BPR EF,BPCOB) S BPSCHED= 1
11393	"RTN","BPS SCRU3",44, 0)
11394	I BPSCHED I ($P(BPS TATUS,U)=" E PAYABLE" )!($P(BPST ATUS,U)="E REVERSAL ACCEPTED") Q "IN PRO GRESS"_U_$ P(BPSTATUS ,U,2)
11395	"RTN","BPS SCRU3",45, 0)
11396	Q $P(BPST ATUS,U,1,3 )
11397	"RTN","BPS SCRU3",46, 0)
11398	;
11399	"RTN","BPS SCRU3",47, 0)
11400	;/**
11401	"RTN","BPS SCRU3",48, 0)
11402	;pointers for RESPO NSE file ( #9002313.0 3) by poin ter in TRA NSACTION f ile #90023 13.59
11403	"RTN","BPS SCRU3",49, 0)
11404	;B59 - pt r to #9002 313.59
11405	"RTN","BPS SCRU3",50, 0)
11406	;BPRESP - ptr to #9 002313.03
11407	"RTN","BPS SCRU3",51, 0)
11408	;BPPOS - position i nside #900 2313.03 (i .e. the nu mber
11409	"RTN","BPS SCRU3",52, 0)
11410	;of the c laim in th e transmis sion - cur rently we always hav e only 1
11411	"RTN","BPS SCRU3",53, 0)
11412	GRESPPOS(B P59,BPRESP ,BPPOS) ;* /
11413	"RTN","BPS SCRU3",54, 0)
11414	I $G(^BPS T(BP59,4)) D ; reve rsal kind of message
11415	"RTN","BPS SCRU3",55, 0)
11416	. S BPRES P=+$P(^BPS T(BP59,4), U,2)
11417	"RTN","BPS SCRU3",56, 0)
11418	. S BPPOS =1
11419	"RTN","BPS SCRU3",57, 0)
11420	E D
11421	"RTN","BPS SCRU3",58, 0)
11422	. S BPRES P=+$P($G(^ BPST(BP59, 0)),U,5)
11423	"RTN","BPS SCRU3",59, 0)
11424	. S BPPOS =+$P($G(^B PST(BP59,0 )),U,9)
11425	"RTN","BPS SCRU3",60, 0)
11426	Q:+BPRESP =0 0
11427	"RTN","BPS SCRU3",61, 0)
11428	Q:+BPPOS= 0 0
11429	"RTN","BPS SCRU3",62, 0)
11430	Q 1
11431	"RTN","BPS SCRU3",63, 0)
11432	;
11433	"RTN","BPS SCRU3",64, 0)
11434	;/**
11435	"RTN","BPS SCRU3",65, 0)
11436	;Messages from the BPS RESPON SE file
11437	"RTN","BPS SCRU3",66, 0)
11438	;BP59 - p tr to 9002 313.59
11439	"RTN","BPS SCRU3",67, 0)
11440	;FIELD - what field to get
11441	"RTN","BPS SCRU3",68, 0)
11442	;
11443	"RTN","BPS SCRU3",69, 0)
11444	GETMESS(FI ELD,BP59) ;
11445	"RTN","BPS SCRU3",70, 0)
11446	I '$G(FIE LD) Q ""
11447	"RTN","BPS SCRU3",71, 0)
11448	I '$G(BP5 9) Q ""
11449	"RTN","BPS SCRU3",72, 0)
11450	N BPRESP, BPPOS
11451	"RTN","BPS SCRU3",73, 0)
11452	; Get res ponse and position i n the BPS RESPONSE f ile
11453	"RTN","BPS SCRU3",74, 0)
11454	I $$GRESP POS(BP59,. BPRESP,.BP POS)=0 Q " "
11455	"RTN","BPS SCRU3",75, 0)
11456	; 504-F4 (Message)
11457	"RTN","BPS SCRU3",76, 0)
11458	I FIELD=5 04 Q $P($G (^BPSR(BPR ESP,504)), U)
11459	"RTN","BPS SCRU3",77, 0)
11460	; 526-FQ (Additiona l Message Informatio n) - Get f irst entry of the mu ltiple)
11461	"RTN","BPS SCRU3",78, 0)
11462	I FIELD=5 26 N MESSA GE,N D Q MESSAGE
11463	"RTN","BPS SCRU3",79, 0)
11464	. N ADDME SS
11465	"RTN","BPS SCRU3",80, 0)
11466	. D ADDME SS^BPSSCRL G(BPRESP,B PPOS,.ADDM ESS)
11467	"RTN","BPS SCRU3",81, 0)
11468	. S MESSA GE=""
11469	"RTN","BPS SCRU3",82, 0)
11470	. S N=$O( ADDMESS("" ))
11471	"RTN","BPS SCRU3",83, 0)
11472	. I N S M ESSAGE=$E( ADDMESS(N) ,1,200)
11473	"RTN","BPS SCRU3",84, 0)
11474	Q ""
11475	"RTN","BPS SCRU3",85, 0)
11476	;
11477	"RTN","BPS SCRU3",86, 0)
11478	;reject m essage fro m RESPONSE file
11479	"RTN","BPS SCRU3",87, 0)
11480	;BP59 - p tr to 9002 313.59
11481	"RTN","BPS SCRU3",88, 0)
11482	;BPARR1 - array to return mes sages (by ref)
11483	"RTN","BPS SCRU3",89, 0)
11484	;BPN1 - i ndex for t he array ( by ref - w ill
11485	"RTN","BPS SCRU3",90, 0)
11486	; be inc remented i f more tha n one node added)
11487	"RTN","BPS SCRU3",91, 0)
11488	;BPMLEN - max lengt h for each string
11489	"RTN","BPS SCRU3",92, 0)
11490	;PBPREF - for prefi x string
11491	"RTN","BPS SCRU3",93, 0)
11492	;compare GETRJCOD f rom BPSSCR U2
11493	"RTN","BPS SCRU3",94, 0)
11494	GETRJCOD(B P59,BPARR1 ,BPN1,BPML EN,PBPREF) ;
11495	"RTN","BPS SCRU3",95, 0)
11496	N BP59DAT S BP59DAT =$G(^BPST( BP59,0))
11497	"RTN","BPS SCRU3",96, 0)
11498	N BPRESP, BPPOS
11499	"RTN","BPS SCRU3",97, 0)
11500	N BPRJCOD
11501	"RTN","BPS SCRU3",98, 0)
11502	N BPRJTXT
11503	"RTN","BPS SCRU3",99, 0)
11504	N BPSTR
11505	"RTN","BPS SCRU3",100 ,0)
11506	N BPRJ
11507	"RTN","BPS SCRU3",101 ,0)
11508	;pointers for RESPO NSE file ( #9002313.0 3) by poin ter in TRA NSACTION f ile #90023 13.59
11509	"RTN","BPS SCRU3",102 ,0)
11510	;get resp onse and p osition
11511	"RTN","BPS SCRU3",103 ,0)
11512	I $$GRESP POS(BP59,. BPRESP,.BP POS)=0 Q
11513	"RTN","BPS SCRU3",104 ,0)
11514	S BPRJ=0
11515	"RTN","BPS SCRU3",105 ,0)
11516	S BPSTR=" "
11517	"RTN","BPS SCRU3",106 ,0)
11518	F S BPRJ =$O(^BPSR( BPRESP,100 0,BPPOS,51 1,BPRJ)) Q :+BPRJ=0 D
11519	"RTN","BPS SCRU3",107 ,0)
11520	. S BPRJC OD=$P($G(^ BPSR(BPRES P,1000,BPP OS,511,BPR J,0)),U)
11521	"RTN","BPS SCRU3",108 ,0)
11522	. Q:$L(BP RJCOD)=0
11523	"RTN","BPS SCRU3",109 ,0)
11524	. S BPRJT XT=$$GETRJ NAM(BPRJCO D)
11525	"RTN","BPS SCRU3",110 ,0)
11526	. S BPN1= BPN1+1,BPA RR1(BPN1)= PBPREF_BPR JTXT
11527	"RTN","BPS SCRU3",111 ,0)
11528	Q BPN1
11529	"RTN","BPS SCRU3",112 ,0)
11530	;/**
11531	"RTN","BPS SCRU3",113 ,0)
11532	;Input:
11533	"RTN","BPS SCRU3",114 ,0)
11534	; BP59 - pointer to file #900 2313.59
11535	"RTN","BPS SCRU3",115 ,0)
11536	; BPSNBR - flag to determine if eT/eC p seudo-reje ct codes s hould also be return ed for non -billable entries
11537	"RTN","BPS SCRU3",116 ,0)
11538	; default is to NOT include th em (leave parameter blank)
11539	"RTN","BPS SCRU3",117 ,0)
11540	;Output:
11541	"RTN","BPS SCRU3",118 ,0)
11542	; BPRCODE S - array for reject codes by reference
11543	"RTN","BPS SCRU3",119 ,0)
11544	REJCODES(B P59,BPRCOD ES,BPSNBR) ;get reje ct codes
11545	"RTN","BPS SCRU3",120 ,0)
11546	N BPRESP, BPPOS,BPA, BPR
11547	"RTN","BPS SCRU3",121 ,0)
11548	;
11549	"RTN","BPS SCRU3",122 ,0)
11550	; get TRI /CVA non-b illable ps eudo-rejec t codes if the flag is set and the entry is non-bi llable (BP S120)
11551	"RTN","BPS SCRU3",123 ,0)
11552	I $G(BPSN BR),$$NB^B PSSCR03(BP 59) D
11553	"RTN","BPS SCRU3",124 ,0)
11554	. S BPR=$ E($$EREJTX T^BPSSCR03 (BP59),1,2 ) ; get the eT or eC pseudo -reject co de
11555	"RTN","BPS SCRU3",125 ,0)
11556	. I BPR'= "" S BPRCO DES(BPR)=" "
11557	"RTN","BPS SCRU3",126 ,0)
11558	. Q
11559	"RTN","BPS SCRU3",127 ,0)
11560	;
11561	"RTN","BPS SCRU3",128 ,0)
11562	;pointers for RESPO NSE file ( #9002313.0 3) by poin ter in TRA NSACTION f ile #90023 13.59
11563	"RTN","BPS SCRU3",129 ,0)
11564	;get resp onse and p osition
11565	"RTN","BPS SCRU3",130 ,0)
11566	I $$GRESP POS(BP59,. BPRESP,.BP POS)=0 Q
11567	"RTN","BPS SCRU3",131 ,0)
11568	;
11569	"RTN","BPS SCRU3",132 ,0)
11570	S BPA=0
11571	"RTN","BPS SCRU3",133 ,0)
11572	F S BPA= $O(^BPSR(B PRESP,1000 ,BPPOS,511 ,BPA)) Q:' BPA D
11573	"RTN","BPS SCRU3",134 ,0)
11574	. S BPR=$ P(^BPSR(BP RESP,1000, BPPOS,511, BPA,0),U)
11575	"RTN","BPS SCRU3",135 ,0)
11576	. I BPR'= "" S BPRCO DES(BPR)=" "
11577	"RTN","BPS SCRU3",136 ,0)
11578	Q
11579	"RTN","BPS SCRU3",137 ,0)
11580	;/**
11581	"RTN","BPS SCRU3",138 ,0)
11582	;BPRJCODE - code
11583	"RTN","BPS SCRU3",139 ,0)
11584	GETRJNAM(B PRJCODE) ; */
11585	"RTN","BPS SCRU3",140 ,0)
11586	N BPRJIEN
11587	"RTN","BPS SCRU3",141 ,0)
11588	S BPRJIEN =$O(^BPSF( 9002313.93 ,"B",BPRJC ODE,0))
11589	"RTN","BPS SCRU3",142 ,0)
11590	Q:+BPRJIE N=0 ""
11591	"RTN","BPS SCRU3",143 ,0)
11592	Q BPRJCOD E_":"_$P($ G(^BPSF(90 02313.93,B PRJIEN,0)) ,U,2)
11593	"RTN","BPS SCRU3",144 ,0)
11594	;/**
11595	"RTN","BPS SCRU3",145 ,0)
11596	;BP59 - p tr to 9002 313.59
11597	"RTN","BPS SCRU3",146 ,0)
11598	;was the claim ever autorever sed ?
11599	"RTN","BPS SCRU3",147 ,0)
11600	AUTOREV(BP 59) ;*/
11601	"RTN","BPS SCRU3",148 ,0)
11602	N BP02
11603	"RTN","BPS SCRU3",149 ,0)
11604	S BP02=+$ P($G(^BPST (BP59,0)), U,4)
11605	"RTN","BPS SCRU3",150 ,0)
11606	Q +$P($G( ^BPSC(BP02 ,0)),U,7)
11607	"RTN","BPS SCRU3",151 ,0)
11608	;
11609	"RTN","BPS SCRU3",152 ,0)
11610	;/**
11611	"RTN","BPS SCRU3",153 ,0)
11612	;BP59 - p tr to 9002 313.59
11613	"RTN","BPS SCRU3",154 ,0)
11614	;returns :
11615	"RTN","BPS SCRU3",155 ,0)
11616	;0 Waitin g to start
11617	"RTN","BPS SCRU3",156 ,0)
11618	;10 Gathe ring claim info
11619	"RTN","BPS SCRU3",157 ,0)
11620	;19 Speci al Groupin g
11621	"RTN","BPS SCRU3",158 ,0)
11622	;30 Waiti ng for pac ket build
11623	"RTN","BPS SCRU3",159 ,0)
11624	;31 Wait for retry (insurer a sleep)
11625	"RTN","BPS SCRU3",160 ,0)
11626	;40 Packe t being bu ilt
11627	"RTN","BPS SCRU3",161 ,0)
11628	;50 Waiti ng for tra nsmit
11629	"RTN","BPS SCRU3",162 ,0)
11630	;51 Wait for retry (comms err or)
11631	"RTN","BPS SCRU3",163 ,0)
11632	;60 Trans mitting
11633	"RTN","BPS SCRU3",164 ,0)
11634	;70 Recei ving Respo nse
11635	"RTN","BPS SCRU3",165 ,0)
11636	;80 Waiti ng to proc ess respon se
11637	"RTN","BPS SCRU3",166 ,0)
11638	;90 Proce ssing resp onse
11639	"RTN","BPS SCRU3",167 ,0)
11640	;99 Done
11641	"RTN","BPS SCRU3",168 ,0)
11642	;
11643	"RTN","BPS SCRU3",169 ,0)
11644	PRCNTG(BP5 9) ;*/
11645	"RTN","BPS SCRU3",170 ,0)
11646	Q +$P($G( ^BPST(BP59 ,0)),U,2)
11647	"RTN","BPS SCRU3",171 ,0)
11648	;
11649	"RTN","BPS SCRU3",172 ,0)
11650	;
11651	"RTN","BPS SCRU3",173 ,0)
11652	LINE(BPN,B PCH) ;
11653	"RTN","BPS SCRU3",174 ,0)
11654	N BP1
11655	"RTN","BPS SCRU3",175 ,0)
11656	S $P(BP1, BPCH,BPN+1 )=""
11657	"RTN","BPS SCRU3",176 ,0)
11658	Q BP1
11659	"RTN","BPS SCRU3",177 ,0)
11660	;
11661	"RTN","BPS SCRU3",178 ,0)
11662	DTTIME(X) ;Convert F M date to displayabl e (mm/dd/y y HH:MM) f ormat.
11663	"RTN","BPS SCRU3",179 ,0)
11664	I +X=0 W ""
11665	"RTN","BPS SCRU3",180 ,0)
11666	N DATE,YR ,BPT,BPM,B PH,BPAP,BP S
11667	"RTN","BPS SCRU3",181 ,0)
11668	I $G(X) S YR=$E(X,1 ,3)+1700
11669	"RTN","BPS SCRU3",182 ,0)
11670	I $G(X) S DATE=$S(X :$E(X,4,5) _"/"_$E(X, 6,7)_"/"_Y R,1:"")
11671	"RTN","BPS SCRU3",183 ,0)
11672	S BPT=$P( X,".",2)
11673	"RTN","BPS SCRU3",184 ,0)
11674	I BPT S:$ L(BPT)<6 B PT=BPT_$E( "000000",1 ,6-$L(BPT) )
11675	"RTN","BPS SCRU3",185 ,0)
11676	S BPH=$E( BPT,1,2),B PM=$E(BPT, 3,4),BPS=$ E(BPT,5,6)
11677	"RTN","BPS SCRU3",186 ,0)
11678	I BPT S D ATE=DATE_" @"_BPH_":" _BPM_":"_B PS
11679	"RTN","BPS SCRU3",187 ,0)
11680	Q $G(DATE )
11681	"RTN","BPS SCRU3",188 ,0)
11682	;
11683	"RTN","BPS SCRU3",189 ,0)
11684	;call IB API to get insurance data, the n select p roper insu rance by i ts name
11685	"RTN","BPS SCRU3",190 ,0)
11686	;get its phone numb er
11687	"RTN","BPS SCRU3",191 ,0)
11688	;input:
11689	"RTN","BPS SCRU3",192 ,0)
11690	; DFN - p atient IEN in #2
11691	"RTN","BPS SCRU3",193 ,0)
11692	; BPDOS - date of s ervice
11693	"RTN","BPS SCRU3",194 ,0)
11694	; BPINSNM - insuran ce name
11695	"RTN","BPS SCRU3",195 ,0)
11696	;output: insurance ien^insura nce name^p hone
11697	"RTN","BPS SCRU3",196 ,0)
11698	GETPHONE(B PDFN,BPDOS ,BPINSNM) ;
11699	"RTN","BPS SCRU3",197 ,0)
11700	N BPX,BPZ Z,BP1,BPPH ONE
11701	"RTN","BPS SCRU3",198 ,0)
11702	S BPPHONE =""
11703	"RTN","BPS SCRU3",199 ,0)
11704	I $$INSUR ^IBBAPI(BP DFN,BPDOS, ,.BPZZ,"1, 6")'=1 Q " "
11705	"RTN","BPS SCRU3",200 ,0)
11706	S BP1="" F S BP1=$ O(BPZZ("IB BAPI","INS UR",BP1)) Q:+BP1=0 D
11707	"RTN","BPS SCRU3",201 ,0)
11708	. I BPINS NM=$P($G(B PZZ("IBBAP I","INSUR" ,BP1,1)),U ,2) S BPPH ONE=$G(BPZ Z("IBBAPI" ,"INSUR",B P1,6)) Q
11709	"RTN","BPS SCRU3",202 ,0)
11710	Q BPPHONE
11711	"RTN","BPS SCRU3",203 ,0)
11712	;
11713	"RTN","BPS SCRU3",204 ,0)
11714	;try to g et insuran ce name an d phone fr om #900231 3.59, #900 2313.57 an d from INS UR^IBBAPI
11715	"RTN","BPS SCRU3",205 ,0)
11716	;input: B P59 - ien in #900231 3.59
11717	"RTN","BPS SCRU3",206 ,0)
11718	;return i nsurance_n ame^phone#
11719	"RTN","BPS SCRU3",207 ,0)
11720	NAMEPHON(B P59) ;
11721	"RTN","BPS SCRU3",208 ,0)
11722	N BPHONE, BPINSNM,BP INSID,BP57 ,BPINSN
11723	"RTN","BPS SCRU3",209 ,0)
11724	S BPHONE= $P($G(^BPS T(BP59,10, +$G(^BPST( BP59,9)),3 )),U,2)
11725	"RTN","BPS SCRU3",210 ,0)
11726	S BPINSNM =$P($G(^BP ST(BP59,10 ,+$G(^BPST (BP59,9)), 0)),U,7)
11727	"RTN","BPS SCRU3",211 ,0)
11728	S BP57=0
11729	"RTN","BPS SCRU3",212 ,0)
11730	F Q:(BPH ONE'="")&( BPINSNM'=" ") S BP57 =$O(^BPSTL ("B",BP59, BP57)) Q:+ BP57=0 D
11731	"RTN","BPS SCRU3",213 ,0)
11732	. S BPINS N=+$G(^BPS TL(BP57,9) )
11733	"RTN","BPS SCRU3",214 ,0)
11734	. S:BPHON E="" BPHON E=$P($G(^B PSTL(BP57, 10,BPINSN, 3)),U,2)
11735	"RTN","BPS SCRU3",215 ,0)
11736	. S:BPINS NM="" BPIN SNM=$P($G( ^BPSTL(BP5 7,10,BPINS N,0)),U,7)
11737	"RTN","BPS SCRU3",216 ,0)
11738	;
11739	"RTN","BPS SCRU3",217 ,0)
11740	I (BPINSN M'="")&(BP HONE="") D
11741	"RTN","BPS SCRU3",218 ,0)
11742	. S BPDOS =+$P($G(^B PST(BP59,1 2)),U,2)\1
11743	"RTN","BPS SCRU3",219 ,0)
11744	. I BPDOS =0 S BPDOS =+$P($G(^B PST(BP59,0 )),U,8)\1
11745	"RTN","BPS SCRU3",220 ,0)
11746	. S BPDFN =+$P($G(^B PST(BP59,0 )),U,6)
11747	"RTN","BPS SCRU3",221 ,0)
11748	. S BPHON E=$$GETPHO NE(BPDFN,B PDOS,BPINS NM)
11749	"RTN","BPS SCRU3",222 ,0)
11750	Q BPINSNM _U_BPHONE
11751	"RTN","BPS SCRU3",223 ,0)
11752	;
11753	"RTN","BPS SCRU3",224 ,0)
11754	COM(BPSRXI ,BPSRXR,BP SCOB,BPSAR RAY) ; Get Comments
11755	"RTN","BPS SCRU3",225 ,0)
11756	; This AP I retrieve s comments for pharm acist from BPS Trans action.
11757	"RTN","BPS SCRU3",226 ,0)
11758	;
11759	"RTN","BPS SCRU3",227 ,0)
11760	; Input: BPSRXI - Prescripti on IEN (Po inter to t he PRESCRI PTION
11761	"RTN","BPS SCRU3",228 ,0)
11762	; file (#52) . This pa rameter is required.
11763	"RTN","BPS SCRU3",229 ,0)
11764	; BPSRXR - Fill Numbe r (0 for o riginal, 1 for 1st r efill,
11765	"RTN","BPS SCRU3",230 ,0)
11766	; 2 for the 2nd refill , etc.). If this pa rameter
11767	"RTN","BPS SCRU3",231 ,0)
11768	; is missing , it will default to zero.
11769	"RTN","BPS SCRU3",232 ,0)
11770	; BPSCOB - Coordinati on of Bene fit value (1-Primary ,
11771	"RTN","BPS SCRU3",233 ,0)
11772	; 2-Secondar y, 3-Terti ary). If not passed in,
11773	"RTN","BPS SCRU3",234 ,0)
11774	; primary is assumed.
11775	"RTN","BPS SCRU3",235 ,0)
11776	;
11777	"RTN","BPS SCRU3",236 ,0)
11778	; Output: BPSARRAY - Return a rray of da ta in the format of:
11779	"RTN","BPS SCRU3",237 ,0)
11780	; Array Nam e(Transact ion Date,C ount Index )=Pharmacy Flag ^
11781	"RTN","BPS SCRU3",238 ,0)
11782	; Comm ent ^ User entering comment
11783	"RTN","BPS SCRU3",239 ,0)
11784	;
11785	"RTN","BPS SCRU3",240 ,0)
11786	N BP59,BP SI,BPSCNT, BPSPFLG,BP SDATE,BPSU SER,BPSCOM ,BPSX
11787	"RTN","BPS SCRU3",241 ,0)
11788	;
11789	"RTN","BPS SCRU3",242 ,0)
11790	I '$G(BPS RXI) Q
11791	"RTN","BPS SCRU3",243 ,0)
11792	;
11793	"RTN","BPS SCRU3",244 ,0)
11794	; Note th at $$IEN59 ^BPSOSRX w ill treat BPSRXR="" as the ori ginal
11795	"RTN","BPS SCRU3",245 ,0)
11796	; fill (0) and BP SCOB="" as primary ( 1)
11797	"RTN","BPS SCRU3",246 ,0)
11798	S BP59=$$ IEN59^BPSO SRX(BPSRXI ,$G(BPSRXR ),$G(BPSCO B))
11799	"RTN","BPS SCRU3",247 ,0)
11800	I '$D(^BP ST(BP59,0) ) Q
11801	"RTN","BPS SCRU3",248 ,0)
11802	;
11803	"RTN","BPS SCRU3",249 ,0)
11804	S (BPSI,B PSCNT)=0
11805	"RTN","BPS SCRU3",250 ,0)
11806	F S BPSI =$O(^BPST( BP59,11,BP SI)) Q:'BP SI D
11807	"RTN","BPS SCRU3",251 ,0)
11808	.S BPSPFL G=$$GET1^D IQ(9002313 .59111,BPS I_","_BP59 ,.04,"I")
11809	"RTN","BPS SCRU3",252 ,0)
11810	.S BPSDAT E=$$GET1^D IQ(9002313 .59111,BPS I_","_BP59 ,.01,"I")
11811	"RTN","BPS SCRU3",253 ,0)
11812	.S BPSUSE R=$$GET1^D IQ(9002313 .59111,BPS I_","_BP59 ,.02,"I")
11813	"RTN","BPS SCRU3",254 ,0)
11814	.S BPSCOM =$$GET1^DI Q(9002313. 59111,BPSI _","_BP59, .03)
11815	"RTN","BPS SCRU3",255 ,0)
11816	.;
11817	"RTN","BPS SCRU3",256 ,0)
11818	.S BPSX=B PSPFLG_"^" _BPSCOM_"^ "_BPSUSER
11819	"RTN","BPS SCRU3",257 ,0)
11820	.S BPSCNT =BPSCNT+1
11821	"RTN","BPS SCRU3",258 ,0)
11822	.S BPSARR AY(BPSDATE ,BPSCNT)=B PSX
11823	"RTN","BPS SCRU3",259 ,0)
11824	Q
11825	"RTN","BPS SCRU3",260 ,0)
11826	;
11827	"RTN","BPS SCRU4")
11828	0^1^B70002 442^B58171 346
11829	"RTN","BPS SCRU4",1,0 )
11830	BPSSCRU4 ; BHAM ISC/S S - ECME S CREEN UTIL ITIES ;05- APR-05
11831	"RTN","BPS SCRU4",2,0 )
11832	;;1.0;E C LAIMS MGMT ENGINE; 1,3,21;J UN 2004;Bu ild 28
11833	"RTN","BPS SCRU4",3,0 )
11834	;;Per VA Directive 6402, this routine s hould not be modifie d.
11835	"RTN","BPS SCRU4",4,0 )
11836	;USER SCR EEN
11837	"RTN","BPS SCRU4",5,0 )
11838	Q
11839	"RTN","BPS SCRU4",6,0 )
11840	;
11841	"RTN","BPS SCRU4",7,0 )
11842	;repeated ly prompts the user for line#
11843	"RTN","BPS SCRU4",8,0 )
11844	;the user should "^ " to quit or enter a correct l ine #
11845	"RTN","BPS SCRU4",9,0 )
11846	;input:
11847	"RTN","BPS SCRU4",10, 0)
11848	; BPROMP T - prompt string
11849	"RTN","BPS SCRU4",11, 0)
11850	; BPTYPE expected user's sel ection on level
11851	"RTN","BPS SCRU4",12, 0)
11852	; of P-p atient or C-claim or PC - both
11853	"RTN","BPS SCRU4",13, 0)
11854	; BPERRM ES - optio nal - the message to display w hen the us er
11855	"RTN","BPS SCRU4",14, 0)
11856	; trie s to make multi line selection
11857	"RTN","BPS SCRU4",15, 0)
11858	; BPDFLT - default value for the promp t (optiona l)
11859	"RTN","BPS SCRU4",16, 0)
11860	;output:
11861	"RTN","BPS SCRU4",17, 0)
11862	; piece 1:
11863	"RTN","BPS SCRU4",18, 0)
11864	; 1 - o kay
11865	"RTN","BPS SCRU4",19, 0)
11866	; <0 - errors
11867	"RTN","BPS SCRU4",20, 0)
11868	; 0 - u ser wants to quit
11869	"RTN","BPS SCRU4",21, 0)
11870	; piece 2: patient ien #2
11871	"RTN","BPS SCRU4",22, 0)
11872	; piece 3: insuran ce ien #36
11873	"RTN","BPS SCRU4",23, 0)
11874	; piece 4: ptr to #9002313.5 9
11875	"RTN","BPS SCRU4",24, 0)
11876	; piece 5: 1st lin e for inde x(es) in L M "VALM" a rray
11877	"RTN","BPS SCRU4",25, 0)
11878	; piece 6: patient 's index
11879	"RTN","BPS SCRU4",26, 0)
11880	; piece 7: claim's index
11881	"RTN","BPS SCRU4",27, 0)
11882	ASKLINE(BP ROMPT,BPTY PE,BPERRME S,BPDFLT) ;
11883	"RTN","BPS SCRU4",28, 0)
11884	N BPRET,B PCNT
11885	"RTN","BPS SCRU4",29, 0)
11886	S BPRET=" ",BPCNT=0
11887	"RTN","BPS SCRU4",30, 0)
11888	F S BPRE T=$$SELLIN E(BPROMPT, BPTYPE,VAL MAR,$G(BPD FLT)) Q:BP RET'<0 D
11889	"RTN","BPS SCRU4",31, 0)
11890	. ;D RE^V ALM4
11891	"RTN","BPS SCRU4",32, 0)
11892	. ;
11893	"RTN","BPS SCRU4",33, 0)
11894	. I BPCNT <1 S BPCNT =BPCNT+1 W !
11895	"RTN","BPS SCRU4",34, 0)
11896	. E S BP CNT=0 D RE ^VALM4
11897	"RTN","BPS SCRU4",35, 0)
11898	. I BPRET =-1 W " - Invalid li ne number" ; (invali d Patient summary li ne)"
11899	"RTN","BPS SCRU4",36, 0)
11900	. I BPRET =-8 W " - ",$S($G(BP ERRMES)]"" :BPERRMES, 1:" Invali d line num ber")
11901	"RTN","BPS SCRU4",37, 0)
11902	. I BPRET =-4 W " - Invalid li ne number" ; (invali d RX line) "
11903	"RTN","BPS SCRU4",38, 0)
11904	. I BPRET =-2 W " - Please sel ect Patien t's summar y line."
11905	"RTN","BPS SCRU4",39, 0)
11906	. I BPRET =-3 W " - Please spe cify RX li ne."
11907	"RTN","BPS SCRU4",40, 0)
11908	. I BPRET <-4 W " - Incorrect format." ; Corrupted array (", BPRET,")"
11909	"RTN","BPS SCRU4",41, 0)
11910	Q BPRET
11911	"RTN","BPS SCRU4",42, 0)
11912	;/**
11913	"RTN","BPS SCRU4",43, 0)
11914	;prompts the user f or line# f or various menu opti on of the User Scree n
11915	"RTN","BPS SCRU4",44, 0)
11916	;input:
11917	"RTN","BPS SCRU4",45, 0)
11918	; BPROMP T - prompt string
11919	"RTN","BPS SCRU4",46, 0)
11920	; BPTYPE - expecte d user's s election o n level
11921	"RTN","BPS SCRU4",47, 0)
11922	; of P-p atient or C-claim or PC - both
11923	"RTN","BPS SCRU4",48, 0)
11924	; BPTMP1 - tempora ry global (VALMAR)
11925	"RTN","BPS SCRU4",49, 0)
11926	; BPDFLT - default value for the promp t (optiona l)
11927	"RTN","BPS SCRU4",50, 0)
11928	;output:
11929	"RTN","BPS SCRU4",51, 0)
11930	; piece 1:
11931	"RTN","BPS SCRU4",52, 0)
11932	; 1 - o kay
11933	"RTN","BPS SCRU4",53, 0)
11934	; <0 - errors
11935	"RTN","BPS SCRU4",54, 0)
11936	; 0 - u ser wants to quit
11937	"RTN","BPS SCRU4",55, 0)
11938	; piece 2: patient ien #2
11939	"RTN","BPS SCRU4",56, 0)
11940	; piece 3: insuran ce ien #36
11941	"RTN","BPS SCRU4",57, 0)
11942	; piece 4: ptr to #9002313.5 9
11943	"RTN","BPS SCRU4",58, 0)
11944	; piece 5: 1st lin e for inde x(es) in L M "VALM" a rray
11945	"RTN","BPS SCRU4",59, 0)
11946	; piece 6: patient 's index
11947	"RTN","BPS SCRU4",60, 0)
11948	; piece 7: claim's index
11949	"RTN","BPS SCRU4",61, 0)
11950	SELLINE(BP ROMPT,BPTY PE,BPTMP1, BPDFLT) ;* /
11951	"RTN","BPS SCRU4",62, 0)
11952	N BPX,BPL INE,BPPATI ND,BPCLMIN D
11953	"RTN","BPS SCRU4",63, 0)
11954	N BPDFN,B PSINSUR,BP 59,BP1LN
11955	"RTN","BPS SCRU4",64, 0)
11956	;
11957	"RTN","BPS SCRU4",65, 0)
11958	; Attempt to determ ine defaul t if none passed in
11959	"RTN","BPS SCRU4",66, 0)
11960	I '$G(BPD FLT) S BPD FLT=$$DEFA ULT(BPTYPE ,BPTMP1)
11961	"RTN","BPS SCRU4",67, 0)
11962	;
11963	"RTN","BPS SCRU4",68, 0)
11964	S BPLINE= $$PROMPT(B PROMPT,$G( BPDFLT))
11965	"RTN","BPS SCRU4",69, 0)
11966	I BPLINE= "^" Q 0
11967	"RTN","BPS SCRU4",70, 0)
11968	S BPPATIN D=+$P(BPLI NE,".")
11969	"RTN","BPS SCRU4",71, 0)
11970	I (BPLINE ["-")!(BPL INE[",") Q -8 ;mult iple line input in n ot allowed
11971	"RTN","BPS SCRU4",72, 0)
11972	I '$D(@BP TMP1@("LMI ND",BPPATI ND)) Q -1 ;the pati ent level doesn't ex ist
11973	"RTN","BPS SCRU4",73, 0)
11974	S BPCLMIN D=+$P(BPLI NE,".",2)
11975	"RTN","BPS SCRU4",74, 0)
11976	I BPTYPE= "P",BPCLMI ND>0 Q -2 ;P was re quested bu t claim po rtion was provided
11977	"RTN","BPS SCRU4",75, 0)
11978	I BPTYPE= "C",BPCLMI ND=0 Q -3 ;C was re quested bu t claim po rtion was not provid ed
11979	"RTN","BPS SCRU4",76, 0)
11980	I '$D(@BP TMP1@("LMI ND",BPPATI ND,BPCLMIN D)) Q -4 ;the claim level doe sn't exist
11981	"RTN","BPS SCRU4",77, 0)
11982	S BPDFN=$ O(@BPTMP1@ ("LMIND",B PPATIND,BP CLMIND,0))
11983	"RTN","BPS SCRU4",78, 0)
11984	I +BPDFN= 0 Q -5 ;e rror
11985	"RTN","BPS SCRU4",79, 0)
11986	S BPSINSU R=$O(@BPTM P1@("LMIND ",BPPATIND ,BPCLMIND, BPDFN,""))
11987	"RTN","BPS SCRU4",80, 0)
11988	I BPSINSU R="" Q -6 ;error
11989	"RTN","BPS SCRU4",81, 0)
11990	;if fract ional part was enter ed
11991	"RTN","BPS SCRU4",82, 0)
11992	I BPCLMIN D>0 D I + BP59=0 Q - 7 ;error
11993	"RTN","BPS SCRU4",83, 0)
11994	. S BP59= $O(@BPTMP1 @("LMIND", BPPATIND,B PCLMIND,BP DFN,BPSINS UR,0))
11995	"RTN","BPS SCRU4",84, 0)
11996	I BPCLMIN D=0 S BP59 =0
11997	"RTN","BPS SCRU4",85, 0)
11998	S BP1LN=$ O(@BPTMP1@ ("LMIND",B PPATIND,BP CLMIND,BPD FN,BPSINSU R,BP59,0))
11999	"RTN","BPS SCRU4",86, 0)
12000	I +BP1LN= 0 Q -7 ;e rror
12001	"RTN","BPS SCRU4",87, 0)
12002	Q "1"_U_B PDFN_U_BPS INSUR_U_BP 59_U_BP1LN _U_BPPATIN D_U_BPCLMI ND
12003	"RTN","BPS SCRU4",88, 0)
12004	;
12005	"RTN","BPS SCRU4",89, 0)
12006	;input:
12007	"RTN","BPS SCRU4",90, 0)
12008	;BPSPROM - prompt t ext
12009	"RTN","BPS SCRU4",91, 0)
12010	;BPSDFVL - default value (opt ional)
12011	"RTN","BPS SCRU4",92, 0)
12012	;returns:
12013	"RTN","BPS SCRU4",93, 0)
12014	; "respon se^"
12015	"RTN","BPS SCRU4",94, 0)
12016	PROMPT(BPS PROM,BPSDF VL) ;
12017	"RTN","BPS SCRU4",95, 0)
12018	N BPRET,D IR,X,Y,DIR UT
12019	"RTN","BPS SCRU4",96, 0)
12020	S BPRET=" ^"
12021	"RTN","BPS SCRU4",97, 0)
12022	S DIR(0)= "F^::2",DI R("A")=BPS PROM
12023	"RTN","BPS SCRU4",98, 0)
12024	I $L($G(B PSDFVL))>0 S DIR("B" )=$G(BPSDF VL)
12025	"RTN","BPS SCRU4",99, 0)
12026	D ^DIR I $D(DIRUT) Q "^"
12027	"RTN","BPS SCRU4",100 ,0)
12028	S $P(BPRE T,U)=Y
12029	"RTN","BPS SCRU4",101 ,0)
12030	Q BPRET
12031	"RTN","BPS SCRU4",102 ,0)
12032	;
12033	"RTN","BPS SCRU4",103 ,0)
12034	;/**
12035	"RTN","BPS SCRU4",104 ,0)
12036	;check an d process user input
12037	"RTN","BPS SCRU4",105 ,0)
12038	;input:
12039	"RTN","BPS SCRU4",106 ,0)
12040	; BPLINE - input s tring
12041	"RTN","BPS SCRU4",107 ,0)
12042	; BPTYPE - expecte d user's s election o n level
12043	"RTN","BPS SCRU4",108 ,0)
12044	; of P-p atient or C-claim or PC - both
12045	"RTN","BPS SCRU4",109 ,0)
12046	; BPTMP1 - tempora ry global (VALMAR)
12047	"RTN","BPS SCRU4",110 ,0)
12048	;output:
12049	"RTN","BPS SCRU4",111 ,0)
12050	; piece 1:
12051	"RTN","BPS SCRU4",112 ,0)
12052	; 1 - o kay
12053	"RTN","BPS SCRU4",113 ,0)
12054	; <0 - errors
12055	"RTN","BPS SCRU4",114 ,0)
12056	; 0 - u ser wants to quit
12057	"RTN","BPS SCRU4",115 ,0)
12058	; piece 2: patient ien #2
12059	"RTN","BPS SCRU4",116 ,0)
12060	; piece 3: insuran ce ien #36
12061	"RTN","BPS SCRU4",117 ,0)
12062	; piece 4: ptr to #9002313.5 9
12063	"RTN","BPS SCRU4",118 ,0)
12064	; piece 5: 1st lin e for inde x(es) in L M "VALM" a rray
12065	"RTN","BPS SCRU4",119 ,0)
12066	; piece 6: patient 's index
12067	"RTN","BPS SCRU4",120 ,0)
12068	; piece 7: claim's index
12069	"RTN","BPS SCRU4",121 ,0)
12070	CHECKLN(BP LINE,BPTYP E,BPTMP1) ;*/
12071	"RTN","BPS SCRU4",122 ,0)
12072	N BPX,BPP ATIND,BPCL MIND
12073	"RTN","BPS SCRU4",123 ,0)
12074	N BPDFN,B PSINSUR,BP 59,BP1LN
12075	"RTN","BPS SCRU4",124 ,0)
12076	I BPLINE= "^" Q 0
12077	"RTN","BPS SCRU4",125 ,0)
12078	S BPPATIN D=+$P(BPLI NE,".")
12079	"RTN","BPS SCRU4",126 ,0)
12080	I '$D(@BP TMP1@("LMI ND",BPPATI ND)) Q -1 ;the pati ent level doesn't ex ist
12081	"RTN","BPS SCRU4",127 ,0)
12082	S BPCLMIN D=+$P(BPLI NE,".",2)
12083	"RTN","BPS SCRU4",128 ,0)
12084	I BPTYPE= "P",BPCLMI ND>0 Q -2 ;P was re quested bu t claim po rtion was provided
12085	"RTN","BPS SCRU4",129 ,0)
12086	I BPTYPE= "C",BPCLMI ND=0 Q -3 ;C was re quested bu t claim po rtion was not provid ed
12087	"RTN","BPS SCRU4",130 ,0)
12088	I '$D(@BP TMP1@("LMI ND",BPPATI ND,BPCLMIN D)) Q -4 ;the claim level doe sn't exist
12089	"RTN","BPS SCRU4",131 ,0)
12090	S BPDFN=$ O(@BPTMP1@ ("LMIND",B PPATIND,BP CLMIND,0))
12091	"RTN","BPS SCRU4",132 ,0)
12092	I +BPDFN= 0 Q -5 ;e rror
12093	"RTN","BPS SCRU4",133 ,0)
12094	S BPSINSU R=$O(@BPTM P1@("LMIND ",BPPATIND ,BPCLMIND, BPDFN,""))
12095	"RTN","BPS SCRU4",134 ,0)
12096	I BPSINSU R="" Q -6 ;error
12097	"RTN","BPS SCRU4",135 ,0)
12098	;if fract ional part was enter ed
12099	"RTN","BPS SCRU4",136 ,0)
12100	I BPCLMIN D>0 D I + BP59=0 Q - 7 ;error
12101	"RTN","BPS SCRU4",137 ,0)
12102	. S BP59= $O(@BPTMP1 @("LMIND", BPPATIND,B PCLMIND,BP DFN,BPSINS UR,0))
12103	"RTN","BPS SCRU4",138 ,0)
12104	I BPCLMIN D=0 S BP59 =0
12105	"RTN","BPS SCRU4",139 ,0)
12106	S BP1LN=$ O(@BPTMP1@ ("LMIND",B PPATIND,BP CLMIND,BPD FN,BPSINSU R,BP59,0))
12107	"RTN","BPS SCRU4",140 ,0)
12108	I +BP1LN= 0 Q -7 ;e rror
12109	"RTN","BPS SCRU4",141 ,0)
12110	Q "1"_U_B PDFN_U_BPS INSUR_U_BP 59_U_BP1LN _U_BPPATIN D_U_BPCLMI ND
12111	"RTN","BPS SCRU4",142 ,0)
12112	;
12113	"RTN","BPS SCRU4",143 ,0)
12114	;
12115	"RTN","BPS SCRU4",144 ,0)
12116	;BPTMP = VALMAR
12117	"RTN","BPS SCRU4",145 ,0)
12118	;input:
12119	"RTN","BPS SCRU4",146 ,0)
12120	; BPROMPT - prompt text
12121	"RTN","BPS SCRU4",147 ,0)
12122	; BPTYPE - expected user's se lection on level
12123	"RTN","BPS SCRU4",148 ,0)
12124	; of P-p atient or C-claim or PC - both
12125	"RTN","BPS SCRU4",149 ,0)
12126	; BPTMP - temporary global (l ike VALMAR )
12127	"RTN","BPS SCRU4",150 ,0)
12128	; BPARRLN 2 - to ret urn result s
12129	"RTN","BPS SCRU4",151 ,0)
12130	;output :
12131	"RTN","BPS SCRU4",152 ,0)
12132	; 1 if o kay
12133	"RTN","BPS SCRU4",153 ,0)
12134	; -1 -in valid form at
12135	"RTN","BPS SCRU4",154 ,0)
12136	; ^ - qu it
12137	"RTN","BPS SCRU4",155 ,0)
12138	; BPARRL N2 - Array (B59)="lin e# in VALM "^"Patient Index.Clai mIndex"
12139	"RTN","BPS SCRU4",156 ,0)
12140	;example:
12141	"RTN","BPS SCRU4",157 ,0)
12142	; BPARR( 30045.0000 1)=134^2.3 4
12143	"RTN","BPS SCRU4",158 ,0)
12144	ASKLINES(B PROMPT,BPT YPE,BPARRL N2,BPTMP) ;
12145	"RTN","BPS SCRU4",159 ,0)
12146	N BPQ,BPX LN,BPN,BPL N,BPZ
12147	"RTN","BPS SCRU4",160 ,0)
12148	N BPL,BPC LM,BPDFLT
12149	"RTN","BPS SCRU4",161 ,0)
12150	N BPARRLN 1,BPX1
12151	"RTN","BPS SCRU4",162 ,0)
12152	;
12153	"RTN","BPS SCRU4",163 ,0)
12154	; Attempt to determ ine defaul t
12155	"RTN","BPS SCRU4",164 ,0)
12156	S BPDFLT= $$DEFAULT( BPTYPE,BPT MP)
12157	"RTN","BPS SCRU4",165 ,0)
12158	;
12159	"RTN","BPS SCRU4",166 ,0)
12160	S BPSPROM ="Select i tem(s)"
12161	"RTN","BPS SCRU4",167 ,0)
12162	S BPLN=$$ PROMPT(BPS PROM,BPDFL T)
12163	"RTN","BPS SCRU4",168 ,0)
12164	I BPLN="^ " Q "^"
12165	"RTN","BPS SCRU4",169 ,0)
12166	S BPLN=$P (BPLN,U)
12167	"RTN","BPS SCRU4",170 ,0)
12168	S BPQ=0
12169	"RTN","BPS SCRU4",171 ,0)
12170	F BPN=1:1 S BPX1=$P (BPLN,",", BPN) Q:$L( BPX1)=0 D Q:BPQ'=0
12171	"RTN","BPS SCRU4",172 ,0)
12172	. S BPZ=$ $MKINDEXS( BPX1,BPTMP ,.BPARRLN1 )
12173	"RTN","BPS SCRU4",173 ,0)
12174	. I BPZ<1 S BPQ=-1
12175	"RTN","BPS SCRU4",174 ,0)
12176	. I (BPZ= -1)!(BPZ=- 2) W !,"In valid form at.",!
12177	"RTN","BPS SCRU4",175 ,0)
12178	. I (BPZ= -3) W !,"N ot a valid selection .",!
12179	"RTN","BPS SCRU4",176 ,0)
12180	Q:BPQ=-1 -1
12181	"RTN","BPS SCRU4",177 ,0)
12182	;
12183	"RTN","BPS SCRU4",178 ,0)
12184	N BPPAT,B PCLM
12185	"RTN","BPS SCRU4",179 ,0)
12186	S BPPAT=0 F S BPPA T=$O(BPARR LN1(BPPAT) ) Q:BPPAT= "" D
12187	"RTN","BPS SCRU4",180 ,0)
12188	. S BPCLM =0 F S BP CLM=$O(BPA RRLN1(BPPA T,BPCLM)) Q:BPCLM="" D
12189	"RTN","BPS SCRU4",181 ,0)
12190	. . S BP1 =$G(BPARRL N1(BPPAT,B PCLM))
12191	"RTN","BPS SCRU4",182 ,0)
12192	. . Q:$L( BP1)=0
12193	"RTN","BPS SCRU4",183 ,0)
12194	. . S BPA RRLN2(+$P( BP1,U,4))= +$P(BP1,U, 5)_U_BPPAT _"."_BPCLM
12195	"RTN","BPS SCRU4",184 ,0)
12196	Q 1
12197	"RTN","BPS SCRU4",185 ,0)
12198	;
12199	"RTN","BPS SCRU4",186 ,0)
12200	;/**
12201	"RTN","BPS SCRU4",187 ,0)
12202	;checks f or dashes and if so then creat e a number of indexe s for the range
12203	"RTN","BPS SCRU4",188 ,0)
12204	;i.e. con vert all " 1.2-2.3" t o "1.2,1.3 ,1.4,2.1,2 .2,2.3"
12205	"RTN","BPS SCRU4",189 ,0)
12206	;AND crea te entries in BPARR for all "r ight" inde xes
12207	"RTN","BPS SCRU4",190 ,0)
12208	;input:
12209	"RTN","BPS SCRU4",191 ,0)
12210	;BPVAL - value to c heck (exmp l: "1.2-2. 4")
12211	"RTN","BPS SCRU4",192 ,0)
12212	;BPTMP1 - global re f with dat a (exmpl: VALMAR)
12213	"RTN","BPS SCRU4",193 ,0)
12214	;BPARR - array with parsed li ne indexes
12215	"RTN","BPS SCRU4",194 ,0)
12216	;output:
12217	"RTN","BPS SCRU4",195 ,0)
12218	;Exmpl:
12219	"RTN","BPS SCRU4",196 ,0)
12220	; BPARR(1 .2)=""
12221	"RTN","BPS SCRU4",197 ,0)
12222	; BPARR(1 .3)=""
12223	"RTN","BPS SCRU4",198 ,0)
12224	; ...
12225	"RTN","BPS SCRU4",199 ,0)
12226	; returns :
12227	"RTN","BPS SCRU4",200 ,0)
12228	; 1 - oka y
12229	"RTN","BPS SCRU4",201 ,0)
12230	; <0 inva lid format
12231	"RTN","BPS SCRU4",202 ,0)
12232	MKINDEXS(B PVAL,BPTMP 1,BPARR) ;
12233	"RTN","BPS SCRU4",203 ,0)
12234	N BPFR,BP TO,BPQ,BPR ET
12235	"RTN","BPS SCRU4",204 ,0)
12236	N BPPAT,B PCLM,BPCLS TRT,BPCLEN D,BPQ2
12237	"RTN","BPS SCRU4",205 ,0)
12238	N BPFRPAT ,BPTOPAT,B PFRCLM,BPT OCLM,BP1
12239	"RTN","BPS SCRU4",206 ,0)
12240	S BPQ=0
12241	"RTN","BPS SCRU4",207 ,0)
12242	S BPRET=1
12243	"RTN","BPS SCRU4",208 ,0)
12244	I BPVAL'[ "-" D Q B PRET
12245	"RTN","BPS SCRU4",209 ,0)
12246	. S BPPAT =$P(BPVAL, ".",1)
12247	"RTN","BPS SCRU4",210 ,0)
12248	. I BPPAT '=+BPPAT S BPRET=-1 Q ;invali d format, patient pa rt is not numeric
12249	"RTN","BPS SCRU4",211 ,0)
12250	. S BPCLM =$P(BPVAL, ".",2)
12251	"RTN","BPS SCRU4",212 ,0)
12252	. ;if onl y patient index
12253	"RTN","BPS SCRU4",213 ,0)
12254	. I $L(BP CLM)=0 D Q
12255	"RTN","BPS SCRU4",214 ,0)
12256	. . S BPQ 2=0
12257	"RTN","BPS SCRU4",215 ,0)
12258	. . F BPC LM=1:1 D Q:BPQ2'=0
12259	"RTN","BPS SCRU4",216 ,0)
12260	. . . ;qu it if ther e are no m ore claims for the p atient
12261	"RTN","BPS SCRU4",217 ,0)
12262	. . . S B P1=$$CHECK LN(BPPAT_" ."_BPCLM," C",BPTMP1)
12263	"RTN","BPS SCRU4",218 ,0)
12264	. . . I B P1<1 S BPQ 2=1 Q
12265	"RTN","BPS SCRU4",219 ,0)
12266	. . . S B PARR(+BPPA T,+BPCLM)= BP1
12267	"RTN","BPS SCRU4",220 ,0)
12268	. ;if onl y patient+ claim inde x
12269	"RTN","BPS SCRU4",221 ,0)
12270	. I BPCLM '=+BPCLM S BPRET=-2 Q ;invali d format, claim port ion is not numeric
12271	"RTN","BPS SCRU4",222 ,0)
12272	. S BP1=$ $CHECKLN(B PPAT_"."_B PCLM,"C",B PTMP1)
12273	"RTN","BPS SCRU4",223 ,0)
12274	. I BP1<1 S BPRET=- 3 Q ;not found
12275	"RTN","BPS SCRU4",224 ,0)
12276	. S BPARR (+BPPAT,+B PCLM)=BP1
12277	"RTN","BPS SCRU4",225 ,0)
12278	;******** * if conta ins "-"
12279	"RTN","BPS SCRU4",226 ,0)
12280	S BPFR=$P (BPVAL,"-" ,1)
12281	"RTN","BPS SCRU4",227 ,0)
12282	S BPTO=$P (BPVAL,"-" ,2)
12283	"RTN","BPS SCRU4",228 ,0)
12284	I BPTO["- " Q -3 ;i nvalid for mat (to ma ny dashes)
12285	"RTN","BPS SCRU4",229 ,0)
12286	S BPFRPAT =$P(BPFR," .",1)
12287	"RTN","BPS SCRU4",230 ,0)
12288	S BPTOPAT =$P(BPTO," .",1)
12289	"RTN","BPS SCRU4",231 ,0)
12290	S BPFRCLM =$P(BPFR," .",2)
12291	"RTN","BPS SCRU4",232 ,0)
12292	I $L(BPFR CLM)=0 S B PFRCLM=1
12293	"RTN","BPS SCRU4",233 ,0)
12294	S BPTOCLM =$P(BPTO," .",2)
12295	"RTN","BPS SCRU4",234 ,0)
12296	I $L(BPTO CLM)=0 S B PTOCLM=999 999
12297	"RTN","BPS SCRU4",235 ,0)
12298	I BPFRPAT '=+BPFRPAT Q -1 ;in valid form at, patien t part is not numeri c
12299	"RTN","BPS SCRU4",236 ,0)
12300	I BPTOPAT '=+BPTOPAT Q -1 ;in valid form at, patien t part is not numeri c
12301	"RTN","BPS SCRU4",237 ,0)
12302	I BPFRCLM '=+BPFRCLM Q -2 ;in valid form at, claim portion is not numer ic
12303	"RTN","BPS SCRU4",238 ,0)
12304	I BPTOCLM '=+BPTOCLM Q -2 ;in valid form at, claim portion is not numer ic
12305	"RTN","BPS SCRU4",239 ,0)
12306	F BPPAT=B PFRPAT:1:B PTOPAT D
12307	"RTN","BPS SCRU4",240 ,0)
12308	. I BPPAT =BPFRPAT S BPCLSTRT= BPFRCLM
12309	"RTN","BPS SCRU4",241 ,0)
12310	. E S BP CLSTRT=1
12311	"RTN","BPS SCRU4",242 ,0)
12312	. I BPPAT =BPTOPAT S BPCLEND=B PTOCLM
12313	"RTN","BPS SCRU4",243 ,0)
12314	. E S BP CLEND=9999 99
12315	"RTN","BPS SCRU4",244 ,0)
12316	. S BPQ2= 0
12317	"RTN","BPS SCRU4",245 ,0)
12318	. F BPCLM =BPCLSTRT: 1:BPCLEND D Q:BPQ2' =0
12319	"RTN","BPS SCRU4",246 ,0)
12320	. . ;quit if there are no mor e claims f or the pat ient
12321	"RTN","BPS SCRU4",247 ,0)
12322	. . S BP1 =$$CHECKLN (BPPAT_"." _BPCLM,"C" ,BPTMP1)
12323	"RTN","BPS SCRU4",248 ,0)
12324	. . I BP1 <1 S BPQ2= 1 Q
12325	"RTN","BPS SCRU4",249 ,0)
12326	. . S BPA RR(+BPPAT, +BPCLM)=BP 1
12327	"RTN","BPS SCRU4",250 ,0)
12328	Q 1
12329	"RTN","BPS SCRU4",251 ,0)
12330	;
12331	"RTN","BPS SCRU4",252 ,0)
12332	; DEFAULT will retu rn a value to be use d as the d efault at the
12333	"RTN","BPS SCRU4",253 ,0)
12334	; Select Item promp t if there is only o ne item on the list. If the
12335	"RTN","BPS SCRU4",254 ,0)
12336	; user mu st enter a patient-l evel item (BPTYPE of "P"), the the
12337	"RTN","BPS SCRU4",255 ,0)
12338	; patient number wi ll be retu rned if on ly one. O therwise t he claim
12339	"RTN","BPS SCRU4",256 ,0)
12340	; number will be re turned if only one p atient and one claim .
12341	"RTN","BPS SCRU4",257 ,0)
12342	; Input: BPTYPE - P if user should ent er a Patie nt
12343	"RTN","BPS SCRU4",258 ,0)
12344	; C if user should ent er a Claim
12345	"RTN","BPS SCRU4",259 ,0)
12346	; PC if user may enter either
12347	"RTN","BPS SCRU4",260 ,0)
12348	; BPLIST - temporary global (VA LMAR)
12349	"RTN","BPS SCRU4",261 ,0)
12350	; Output: $$DEFAUL T - Either a patient number, o r a claim number,
12351	"RTN","BPS SCRU4",262 ,0)
12352	; or <blank> if neithe r could be defaulted
12353	"RTN","BPS SCRU4",263 ,0)
12354	DEFAULT(BP TYPE,BPLIS T) ; Dete rmine defa ult item n umber - BP S1.021
12355	"RTN","BPS SCRU4",264 ,0)
12356	N BPSCLAI M,BPSPATIE NT
12357	"RTN","BPS SCRU4",265 ,0)
12358	S BPSPATI ENT=$O(@BP LIST@("LMI ND",0))
12359	"RTN","BPS SCRU4",266 ,0)
12360	I $O(@BPL IST@("LMIN D",BPSPATI ENT))'="" Q "" ; if not one pa tient, Qui t ""
12361	"RTN","BPS SCRU4",267 ,0)
12362	I BPTYPE= "P" Q BPSP ATIENT ; i f BPTYPE i s P(atient ), then Qu it with th e patient
12363	"RTN","BPS SCRU4",268 ,0)
12364	S BPSCLAI M=$O(@BPLI ST@("LMIND ",BPSPATIE NT,0))
12365	"RTN","BPS SCRU4",269 ,0)
12366	I $O(@BPL IST@("LMIN D",BPSPATI ENT,BPSCLA IM))'="" Q "" ; if n ot one cla im, Quit " "
12367	"RTN","BPS SCRU4",270 ,0)
12368	Q BPSPATI ENT_"."_BP SCLAIM
12369	"RTN","BPS SCRU4",271 ,0)
12370	;
12371	"UP",90023 13.02,9002 313.0201,- 1)
12372	9002313.02 ^400
12373	"UP",90023 13.02,9002 313.0201,0 )
12374	9002313.02 01
12375	"VER")
12376	8.0^22.2
12377	"^DD",9002 313.02,900 2313.0201, 2096,0)
12378	PROVIDER F IRST NAME^ FJ35^^B90; 6^K:$L(X)> 35!($L(X)< 1) X
12379	"^DD",9002 313.02,900 2313.0201, 2096,3)
12380	Enter a fi rst name 1 -35 charac ters in le ngth.
12381	"^DD",9002 313.02,900 2313.0201, 2096,21,0)
12382	^^2^2^3170 228^
12383	"^DD",9002 313.02,900 2313.0201, 2096,21,1, 0)
12384	The First Name of th e provider of the pr oduct/serv ice.
12385	"^DD",9002 313.02,900 2313.0201, 2096,21,2, 0)
12386	NCPDP stan dard field B96-4A.
12387	"^DD",9002 313.02,900 2313.0201, 2096,23,0)
12388	^^1^1^3170 228^
12389	"^DD",9002 313.02,900 2313.0201, 2096,23,1, 0)
12390	PHARMACY P ROVIDER SE GMENT
12391	"^DD",9002 313.02,900 2313.0201, 2096,"DT")
12392	3170301
12393	"^DD",9002 313.02,900 2313.0201, 2097,0)
12394	PROVIDER L AST NAME^F J35^^B90;7 ^K:$L(X)>3 5!($L(X)<1 ) X
12395	"^DD",9002 313.02,900 2313.0201, 2097,3)
12396	Enter a la st name 1- 35 charact ers in len gth.
12397	"^DD",9002 313.02,900 2313.0201, 2097,21,0)
12398	^^2^2^3170 228^
12399	"^DD",9002 313.02,900 2313.0201, 2097,21,1, 0)
12400	The Last N ame of the provider of the pro duct/servi ce.
12401	"^DD",9002 313.02,900 2313.0201, 2097,21,2, 0)
12402	NCPDP stan dard field B97-4M.
12403	"^DD",9002 313.02,900 2313.0201, 2097,23,0)
12404	^^1^1^3170 228^
12405	"^DD",9002 313.02,900 2313.0201, 2097,23,1, 0)
12406	PHARMACY P ROVIDER SE GMENT
12407	"^DD",9002 313.02,900 2313.0201, 2097,"DT")
12408	3170301
12409	"^DD",9002 313.02,900 2313.0201, 2101,0)
12410	ORIG MANUF ACTURER PR ODUCT ID^F J19^^C00;1 ^K:$L(X)>1 9!($L(X)<1 ) X
12411	"^DD",9002 313.02,900 2313.0201, 2101,3)
12412	Enter a va lue 1-19 c haracters in length.
12413	"^DD",9002 313.02,900 2313.0201, 2101,21,0)
12414	^^2^2^3170 228^
12415	"^DD",9002 313.02,900 2313.0201, 2101,21,1, 0)
12416	ID assigne d to the o riginal ma nufacturer of the pr oduct.
12417	"^DD",9002 313.02,900 2313.0201, 2101,21,2, 0)
12418	NCPDP stan dard field C01-4N.
12419	"^DD",9002 313.02,900 2313.0201, 2101,23,0)
12420	^^1^1^3170 228^
12421	"^DD",9002 313.02,900 2313.0201, 2101,23,1, 0)
12422	CLAIM SEGM ENT
12423	"^DD",9002 313.02,900 2313.0201, 2101,"DT")
12424	3170301
12425	"^DD",9002 313.02,900 2313.0201, 2102,0)
12426	ORIG MANUF ACTURER PR OD ID QUAL ^S^3:NDC-N ation Drug code;^C00 ;2^Q
12427	"^DD",9002 313.02,900 2313.0201, 2102,3)
12428	Enter '3' or leave b lank if th e Product ID is empt y.
12429	"^DD",9002 313.02,900 2313.0201, 2102,21,0)
12430	^^2^2^3170 301^
12431	"^DD",9002 313.02,900 2313.0201, 2102,21,1, 0)
12432	Qualifies Original M anufacture r Product ID C01-4N.
12433	"^DD",9002 313.02,900 2313.0201, 2102,21,2, 0)
12434	NCPDP stan dard field C02-4P.
12435	"^DD",9002 313.02,900 2313.0201, 2102,23,0)
12436	^^1^1^3170 228^
12437	"^DD",9002 313.02,900 2313.0201, 2102,23,1, 0)
12438	CLAIM SEGM ENT
12439	"^DD",9002 313.02,900 2313.0201, 2102,"DT")
12440	3170301
12441	"^DD",9002 313.25,900 2313.25,0)
12442	FIELD^^.02 ^2
12443	"^DD",9002 313.25,900 2313.25,0, "DDA")
12444	N
12445	"^DD",9002 313.25,900 2313.25,0, "DT")
12446	3071212
12447	"^DD",9002 313.25,900 2313.25,0, "ID",.02)
12448	W " ",$P (^(0),U,2)
12449	"^DD",9002 313.25,900 2313.25,0, "IX","B",9 002313.25, .01)
12450
12451	"^DD",9002 313.25,900 2313.25,0, "NM","BPS NCPDP CLAR IFICATION CODES")
12452
12453	"^DD",9002 313.25,900 2313.25,0, "VRPK")
12454	BPS
12455	"^DD",9002 313.25,900 2313.25,.0 1,0)
12456	CODE^RF^^0 ;1^K:$L(X) >2!($L(X)< 1)!'(X'?1P .E) X
12457	"^DD",9002 313.25,900 2313.25,.0 1,1,0)
12458	^.1
12459	"^DD",9002 313.25,900 2313.25,.0 1,1,1,0)
12460	9002313.25 ^B
12461	"^DD",9002 313.25,900 2313.25,.0 1,1,1,1)
12462	S ^BPS(900 2313.25,"B ",$E(X,1,3 0),DA)=""
12463	"^DD",9002 313.25,900 2313.25,.0 1,1,1,2)
12464	K ^BPS(900 2313.25,"B ",$E(X,1,3 0),DA)
12465	"^DD",9002 313.25,900 2313.25,.0 1,3)
12466	Answer mus t be 1-2 c haracters in length.
12467	"^DD",9002 313.25,900 2313.25,.0 1,21,0)
12468	^^2^2^3080 613^
12469	"^DD",9002 313.25,900 2313.25,.0 1,21,1,0)
12470	Clarificat ion code t o be sent to the pay er as defi ned by the NCPDP
12471	"^DD",9002 313.25,900 2313.25,.0 1,21,2,0)
12472	standard.
12473	"^DD",9002 313.25,900 2313.25,.0 1,"DT")
12474	3080613
12475	"^DD",9002 313.25,900 2313.25,.0 2,0)
12476	DESCRIPTIO N^FX^^0;2^ K:$L(X)>80 !($L(X)<1) X S:$D(X) X=$$UP^XL FSTR(X)
12477	"^DD",9002 313.25,900 2313.25,.0 2,3)
12478	Answer mus t be 1-80 characters in length .
12479	"^DD",9002 313.25,900 2313.25,.0 2,21,0)
12480	^^1^1^3080 613^
12481	"^DD",9002 313.25,900 2313.25,.0 2,21,1,0)
12482	Descriptio n of the c larificati on code.
12483	"^DD",9002 313.25,900 2313.25,.0 2,"DT")
12484	3080613
12485	"^DD",9002 313.91,900 2313.91,0)
12486	FIELD^^1^1 3
12487	"^DD",9002 313.91,900 2313.91,0, "DDA")
12488	N
12489	"^DD",9002 313.91,900 2313.91,0, "DT")
12490	3130222
12491	"^DD",9002 313.91,900 2313.91,0, "ID",.03)
12492	W " ",$P (^(0),U,3)
12493	"^DD",9002 313.91,900 2313.91,0, "IX","B",9 002313.91, .01)
12494
12495	"^DD",9002 313.91,900 2313.91,0, "IX","C",9 002313.91, .03)
12496
12497	"^DD",9002 313.91,900 2313.91,0, "IX","D",9 002313.91, .06)
12498
12499	"^DD",9002 313.91,900 2313.91,0, "NM","BPS NCPDP FIEL D DEFS")
12500
12501	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.311,.01 )
12502
12503	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.3121,.0 1)
12504
12505	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.5111,.0 1)
12506
12507	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9205,.0 2)
12508
12509	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9206,.0 2)
12510
12511	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9207,.0 2)
12512
12513	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9208,.0 2)
12514
12515	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9209,.0 2)
12516
12517	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.921,.02 )
12518
12519	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9213,.0 2)
12520
12521	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9214,.0 2)
12522
12523	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9215,.0 2)
12524
12525	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9216,.0 2)
12526
12527	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9217,.0 2)
12528
12529	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9218,.0 2)
12530
12531	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9219,.0 2)
12532
12533	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.922,.02 )
12534
12535	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9223,.0 2)
12536
12537	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9224,.0 2)
12538
12539	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9225,.0 2)
12540
12541	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9227,.0 2)
12542
12543	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9228,.0 2)
12544
12545	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.9229,.0 2)
12546
12547	"^DD",9002 313.91,900 2313.91,0, "PT",90023 13.923,.02 )
12548
12549	"^DD",9002 313.91,900 2313.91,0, "VRPK")
12550	BPS
12551	"^DD",9002 313.91,900 2313.91,.0 1,0)
12552	NCPDP FIEL D NUMBER^R FX^^0;1^K: $L(X)>6!($ L(X)<3) X
12553	"^DD",9002 313.91,900 2313.91,.0 1,1,0)
12554	^.1
12555	"^DD",9002 313.91,900 2313.91,.0 1,1,1,0)
12556	9002313.91 ^B
12557	"^DD",9002 313.91,900 2313.91,.0 1,1,1,1)
12558	S ^BPSF(90 02313.91," B",$E(X,1, 30),DA)=""
12559	"^DD",9002 313.91,900 2313.91,.0 1,1,1,2)
12560	K ^BPSF(90 02313.91," B",$E(X,1, 30),DA)
12561	"^DD",9002 313.91,900 2313.91,.0 1,3)
12562	Enter the NCPDP fiel d number ( either 0-9 97, 2 Deci mal Digits or 3 Alph anumerics) .
12563	"^DD",9002 313.91,900 2313.91,.0 1,21,0)
12564	^^1^1^3101 014^
12565	"^DD",9002 313.91,900 2313.91,.0 1,21,1,0)
12566	This is th e NCPDP fi eld number as specif ied in the NCPDP dat a dictiona ry.
12567	"^DD",9002 313.91,900 2313.91,.0 1,"DT")
12568	3170227
12569	"^DD",9002 313.91,900 2313.91,.0 3,0)
12570	NAME^F^^0; 3^K:$L(X)> 30!($L(X)< 3) X
12571	"^DD",9002 313.91,900 2313.91,.0 3,1,0)
12572	^.1
12573	"^DD",9002 313.91,900 2313.91,.0 3,1,1,0)
12574	9002313.91 ^C
12575	"^DD",9002 313.91,900 2313.91,.0 3,1,1,1)
12576	S ^BPSF(90 02313.91," C",$E(X,1, 30),DA)=""
12577	"^DD",9002 313.91,900 2313.91,.0 3,1,1,2)
12578	K ^BPSF(90 02313.91," C",$E(X,1, 30),DA)
12579	"^DD",9002 313.91,900 2313.91,.0 3,1,1,"DT" )
12580	3001007
12581	"^DD",9002 313.91,900 2313.91,.0 3,3)
12582	Answer mus t be 3-30 characters in length .
12583	"^DD",9002 313.91,900 2313.91,.0 3,21,0)
12584	^^2^2^3071 227^
12585	"^DD",9002 313.91,900 2313.91,.0 3,21,1,0)
12586	Descriptiv e name the tells wha t the fiel d is withi n the phar macy
12587	"^DD",9002 313.91,900 2313.91,.0 3,21,2,0)
12588	environmen t.
12589	"^DD",9002 313.91,900 2313.91,.0 3,"DT")
12590	3071227
12591	"^DD",9002 313.91,900 2313.91,.0 4,0)
12592	FORMAT^S^N :NUMERIC;A /N:ALPHA/N UMERIC;D:S IGNED NUME RIC;^0;4^Q
12593	"^DD",9002 313.91,900 2313.91,.0 4,3)
12594	Enter the field's fo rmat type.
12595	"^DD",9002 313.91,900 2313.91,.0 4,21,0)
12596	^^1^1^3071 227^
12597	"^DD",9002 313.91,900 2313.91,.0 4,21,1,0)
12598	This is th e format o f the fiel d used wit hin the NC PDP standa rd.
12599	"^DD",9002 313.91,900 2313.91,.0 4,"DT")
12600	3071227
12601	"^DD",9002 313.91,900 2313.91,.0 6,0)
12602	ID^F^^5;1^ K:$L(X)>2! ($L(X)<2) X
12603	"^DD",9002 313.91,900 2313.91,.0 6,1,0)
12604	^.1
12605	"^DD",9002 313.91,900 2313.91,.0 6,1,1,0)
12606	9002313.91 ^D
12607	"^DD",9002 313.91,900 2313.91,.0 6,1,1,1)
12608	S ^BPSF(90 02313.91," D",$E(X,1, 30),DA)=""
12609	"^DD",9002 313.91,900 2313.91,.0 6,1,1,2)
12610	K ^BPSF(90 02313.91," D",$E(X,1, 30),DA)
12611	"^DD",9002 313.91,900 2313.91,.0 6,1,1,"%D" ,0)
12612	^^3^3^3020 807^
12613	"^DD",9002 313.91,900 2313.91,.0 6,1,1,"%D" ,1,0)
12614	Cross refe rence of t he 5.1 Fie ld ID. Th is cross r eference w ill be use d in
12615	"^DD",9002 313.91,900 2313.91,.0 6,1,1,"%D" ,2,0)
12616	the proces sing of th e response as a mean s of trans lating the value to a
12617	"^DD",9002 313.91,900 2313.91,.0 6,1,1,"%D" ,3,0)
12618	field numb er.
12619	"^DD",9002 313.91,900 2313.91,.0 6,1,1,"DT" )
12620	3020807
12621	"^DD",9002 313.91,900 2313.91,.0 6,3)
12622	Answer mus t be 2 cha racters in length.
12623	"^DD",9002 313.91,900 2313.91,.0 6,21,0)
12624	^^3^3^3071 227^
12625	"^DD",9002 313.91,900 2313.91,.0 6,21,1,0)
12626	The same a s the .02 field, but for speci fic use wh en creatin g 5.1
12627	"^DD",9002 313.91,900 2313.91,.0 6,21,2,0)
12628	claims. T he 5.1 fie lds were s eparated b ecause 3.x and 5.1 c laims were
12629	"^DD",9002 313.91,900 2313.91,.0 6,21,3,0)
12630	being subm itted conc urrently.
12631	"^DD",9002 313.91,900 2313.91,.0 6,"DT")
12632	3071227
12633	"^DD",9002 313.91,900 2313.91,.0 7,0)
12634	LENGTH^NJ4 ,0^^5;2^K: +X'=X!(X>9 999)!(X<1) !(X?.E1"." 1.N) X
12635	"^DD",9002 313.91,900 2313.91,.0 7,3)
12636	Type a num ber betwee n 1 and 99 99, 0 Deci mal Digits
12637	"^DD",9002 313.91,900 2313.91,.0 7,21,0)
12638	^^1^1^3040 121^
12639	"^DD",9002 313.91,900 2313.91,.0 7,21,1,0)
12640	Length of the field from the 5 .1 NCPDP s tandard.
12641	"^DD",9002 313.91,900 2313.91,.0 7,"DT")
12642	3071227
12643	"^DD",9002 313.91,900 2313.91,.0 8,0)
12644	D0 LENGTH^ NJ3,0^^0;8 ^K:+X'=X!( X>999)!(X< 1)!(X?.E1" ."1N.N) X
12645	"^DD",9002 313.91,900 2313.91,.0 8,3)
12646	Enter the length of the NCPDP field per the NCPDP data dicti onary (1-9 99).
12647	"^DD",9002 313.91,900 2313.91,.0 8,21,0)
12648	^^2^2^3101 014^
12649	"^DD",9002 313.91,900 2313.91,.0 8,21,1,0)
12650	This is th e NCPDP le ngth as sp ecified in the NCPDP Telecommu nication
12651	"^DD",9002 313.91,900 2313.91,.0 8,21,2,0)
12652	Standard v ersion D.0 data dict ionary.
12653	"^DD",9002 313.91,900 2313.91,.0 8,"DT")
12654	3101014
12655	"^DD",9002 313.91,900 2313.91,.0 9,0)
12656	D0 FORMAT^ S^N:NUMERI C;A/N:ALPH ANUMERIC;D :SIGNED NU MERIC;^0;9 ^Q
12657	"^DD",9002 313.91,900 2313.91,.0 9,3)
12658	Enter the data type for the fi eld based on the NCP DP data di ctionary.
12659	"^DD",9002 313.91,900 2313.91,.0 9,21,0)
12660	^^2^2^3101 014^
12661	"^DD",9002 313.91,900 2313.91,.0 9,21,1,0)
12662	This is th e NCPDP da ta type as specified in the NC PDP Teleco mmunicatio n
12663	"^DD",9002 313.91,900 2313.91,.0 9,21,2,0)
12664	Standard v ersion D.0 data dict ionary.
12665	"^DD",9002 313.91,900 2313.91,.0 9,"DT")
12666	3101014
12667	"^DD",9002 313.91,900 2313.91,1, 0)
12668	VISTA FIEL D NUMBER^N J4,0^^5;3^ K:+X'=X!(X >2999)!(X< 1001)!(X?. E1"."1.N) X
12669	"^DD",9002 313.91,900 2313.91,1, 3)
12670	Type a num ber betwee n 1001 and 2999, 0 d ecimal dig its.
12671	"^DD",9002 313.91,900 2313.91,1, 21,0)
12672	^^5^5^3130 424^
12673	"^DD",9002 313.91,900 2313.91,1, 21,1,0)
12674	This is th e VistA fi eld number used in B PS CLAIMS file #9002 313.02 and BPS
12675	"^DD",9002 313.91,900 2313.91,1, 21,2,0)
12676	RESPONSES file #9002 313.03. On ly used fo r NCPDP nu mbers wher e the firs t
12677	"^DD",9002 313.91,900 2313.91,1, 21,3,0)
12678	piece of t he NCPDP n umber is n on-numeric .
12679	"^DD",9002 313.91,900 2313.91,1, 21,4,0)
12680
12681	"^DD",9002 313.91,900 2313.91,1, 21,5,0)
12682	For exampl e, NCPDP f ield B04-B T - Next A vailable F ill Date.
12683	"^DD",9002 313.91,900 2313.91,1, "DT")
12684	3130424
12685	"^DD",9002 313.91,900 2313.91,1. 01,0)
12686	STANDARD N CPDP FIELD NAME^F^^1 ;1^K:$L(X) >100!($L(X )<1) X
12687	"^DD",9002 313.91,900 2313.91,1. 01,3)
12688	Enter the full NCPDP field nam e based on the NCPDP data dict ionary (1- 100 charac ters).
12689	"^DD",9002 313.91,900 2313.91,1. 01,21,0)
12690	^^3^3^3101 014^
12691	"^DD",9002 313.91,900 2313.91,1. 01,21,1,0)
12692	This field is used f or those N CPDP field names tha t were too long to f it
12693	"^DD",9002 313.91,900 2313.91,1. 01,21,2,0)
12694	in the NAM E (#.03) f ield. For those fie lds, this field will
12695	"^DD",9002 313.91,900 2313.91,1. 01,21,3,0)
12696	have the f ull NCPDP field name .
12697	"^DD",9002 313.91,900 2313.91,1. 01,"DT")
12698	3110706
12699	"^DD",9002 313.91,900 2313.91,10 ,0)
12700	GET CODE^9 002313.910 1^^10;0
12701	"^DD",9002 313.91,900 2313.91,10 ,3)
12702	Enter the M code to extract th e data for this fiel d.
12703	"^DD",9002 313.91,900 2313.91,10 ,9)
12704	@
12705	"^DD",9002 313.91,900 2313.91,10 ,21,0)
12706	^.001^2^2^ 3101001^^
12707	"^DD",9002 313.91,900 2313.91,10 ,21,1,0)
12708	M code tha t tells th e BPS syst em where t o find the
12709	"^DD",9002 313.91,900 2313.91,10 ,21,2,0)
12710	particular piece of data for t his field.
12711	"^DD",9002 313.91,900 2313.91,10 ,"DT")
12712	3071227
12713	"^DD",9002 313.91,900 2313.91,20 ,0)
12714	D0 FORMAT CODE^90023 13.9102^^2 0;0
12715	"^DD",9002 313.91,900 2313.91,20 ,9)
12716	@
12717	"^DD",9002 313.91,900 2313.91,20 ,21,0)
12718	^^4^4^3101 014^
12719	"^DD",9002 313.91,900 2313.91,20 ,21,1,0)
12720	This field holds the M code us ed to form at the dat a accordin g to the
12721	"^DD",9002 313.91,900 2313.91,20 ,21,2,0)
12722	specificat ions of th e NCPDP Te lecommunic ation Stan dard versi on D.0 dat a
12723	"^DD",9002 313.91,900 2313.91,20 ,21,3,0)
12724	dictionary . For ins tance, alp hanumeric fields are right-pad ded with
12725	"^DD",9002 313.91,900 2313.91,20 ,21,4,0)
12726	spaces up to the len gth of the specified by the NC PDP standa rd.
12727	"^DD",9002 313.91,900 2313.91,20 ,"DT")
12728	3101005
12729	"^DD",9002 313.91,900 2313.91,30 ,0)
12730	SET CODE^9 002313.910 3^^30;0
12731	"^DD",9002 313.91,900 2313.91,30 ,3)
12732	Enter the M code for the field 's data st orage.
12733	"^DD",9002 313.91,900 2313.91,30 ,9)
12734	@
12735	"^DD",9002 313.91,900 2313.91,30 ,21,0)
12736	^^1^1^3040 326^
12737	"^DD",9002 313.91,900 2313.91,30 ,21,1,0)
12738	M code to store the data in th e appropri ate segmen t within t he claim.
12739	"^DD",9002 313.91,900 2313.91,30 ,"DT")
12740	3071227
12741	"^DD",9002 313.91,900 2313.91,40 ,0)
12742	FORMAT COD E^9002313. 9104^^25;0
12743	"^DD",9002 313.91,900 2313.91,40 ,3)
12744	Enter the M code to format the data in N CPDP forma t.
12745	"^DD",9002 313.91,900 2313.91,40 ,9)
12746	@
12747	"^DD",9002 313.91,900 2313.91,40 ,21,0)
12748	^^2^2^3071 227^
12749	"^DD",9002 313.91,900 2313.91,40 ,21,1,0)
12750	M code to format the data befo re storing it in the claim. 5 .1 was
12751	"^DD",9002 313.91,900 2313.91,40 ,21,2,0)
12752	separate b ecause 3.2 and 5.1 c laims were being sub mitted at the same t ime.
12753	"^DD",9002 313.91,900 2313.91,40 ,"DT")
12754	3071227
12755	"^DD",9002 313.91,900 2313.9101, 0)
12756	GET CODE S UB-FIELD^^ .01^1
12757	"^DD",9002 313.91,900 2313.9101, 0,"DT")
12758	3071227
12759	"^DD",9002 313.91,900 2313.9101, 0,"NM","GE T CODE")
12760
12761	"^DD",9002 313.91,900 2313.9101, 0,"UP")
12762	9002313.91
12763	"^DD",9002 313.91,900 2313.9101, .01,0)
12764	GET CODE^W L^^0;1^Q
12765	"^DD",9002 313.91,900 2313.9101, .01,3)
12766	Enter the M code to extract th e data for this fiel d.
12767	"^DD",9002 313.91,900 2313.9101, .01,9)
12768	@
12769	"^DD",9002 313.91,900 2313.9101, .01,"DT")
12770	3071227
12771	"^DD",9002 313.91,900 2313.9102, 0)
12772	D0 FORMAT CODE SUB-F IELD^^.01^ 1
12773	"^DD",9002 313.91,900 2313.9102, 0,"DT")
12774	3100721
12775	"^DD",9002 313.91,900 2313.9102, 0,"NM","D0 FORMAT CO DE")
12776
12777	"^DD",9002 313.91,900 2313.9102, 0,"UP")
12778	9002313.91
12779	"^DD",9002 313.91,900 2313.9102, .01,0)
12780	D0 FORMAT CODE^WLx^^ 0;1^Q
12781	"^DD",9002 313.91,900 2313.9102, .01,"DT")
12782	3101014
12783	"^DD",9002 313.91,900 2313.9103, 0)
12784	SET CODE S UB-FIELD^^ .01^1
12785	"^DD",9002 313.91,900 2313.9103, 0,"DT")
12786	2950420
12787	"^DD",9002 313.91,900 2313.9103, 0,"NM","SE T CODE")
12788
12789	"^DD",9002 313.91,900 2313.9103, 0,"UP")
12790	9002313.91
12791	"^DD",9002 313.91,900 2313.9103, .01,0)
12792	SET CODE^W L^^0;1^Q
12793	"^DD",9002 313.91,900 2313.9103, .01,3)
12794	Enter the M code for the field 's data st orage.
12795	"^DD",9002 313.91,900 2313.9103, .01,9)
12796	@
12797	"^DD",9002 313.91,900 2313.9103, .01,"DT")
12798	3071227
12799	"^DD",9002 313.91,900 2313.9104, 0)
12800	FORMAT COD E SUB-FIEL D^^.01^1
12801	"^DD",9002 313.91,900 2313.9104, 0,"DT")
12802	3020724
12803	"^DD",9002 313.91,900 2313.9104, 0,"NM","FO RMAT CODE" )
12804
12805	"^DD",9002 313.91,900 2313.9104, 0,"UP")
12806	9002313.91
12807	"^DD",9002 313.91,900 2313.9104, .01,0)
12808	FORMAT COD E^WL^^0;1^ Q
12809	"^DD",9002 313.91,900 2313.9104, .01,3)
12810	Enter the M code to format the data in N CPDP forma t.
12811	"^DD",9002 313.91,900 2313.9104, .01,9)
12812	@
12813	"^DD",9002 313.91,900 2313.9104, .01,"DT")
12814	3071227
12815	"^DD",9002 313.93,900 2313.93,0)
12816	FIELD^^.02 ^2
12817	"^DD",9002 313.93,900 2313.93,0, "DDA")
12818	N
12819	"^DD",9002 313.93,900 2313.93,0, "DT")
12820	3030820
12821	"^DD",9002 313.93,900 2313.93,0, "ID",.02)
12822	W " ",$P (^(0),U,2)
12823	"^DD",9002 313.93,900 2313.93,0, "IX","B",9 002313.93, .01)
12824
12825	"^DD",9002 313.93,900 2313.93,0, "NM","BPS NCPDP REJE CT CODES")
12826
12827	"^DD",9002 313.93,900 2313.93,0, "PT",52.86 5,.01)
12828
12829	"^DD",9002 313.93,900 2313.93,0, "PT",52.86 51,.01)
12830
12831	"^DD",9002 313.93,900 2313.93,0, "PT",90023 13.321,.01 )
12832
12833	"^DD",9002 313.93,900 2313.93,0, "VRPK")
12834	BPS
12835	"^DD",9002 313.93,900 2313.93,.0 1,0)
12836	CODE^RF^^0 ;1^K:$L(X) >3!($L(X)< 2) X
12837	"^DD",9002 313.93,900 2313.93,.0 1,1,0)
12838	^.1
12839	"^DD",9002 313.93,900 2313.93,.0 1,1,1,0)
12840	9002313.93 ^B
12841	"^DD",9002 313.93,900 2313.93,.0 1,1,1,1)
12842	S ^BPSF(90 02313.93," B",$E(X,1, 30),DA)=""
12843	"^DD",9002 313.93,900 2313.93,.0 1,1,1,2)
12844	K ^BPSF(90 02313.93," B",$E(X,1, 30),DA)
12845	"^DD",9002 313.93,900 2313.93,.0 1,3)
12846	Enter the Reject Cod e that is returned f rom the pa yer.
12847	"^DD",9002 313.93,900 2313.93,.0 1,21,0)
12848	^^2^2^3080 529^
12849	"^DD",9002 313.93,900 2313.93,.0 1,21,1,0)
12850	Reject Cod e returned by the pa yer for th e reason o f the reje ction. Th is
12851	"^DD",9002 313.93,900 2313.93,.0 1,21,2,0)
12852	is based o n the NCPD P standard s.
12853	"^DD",9002 313.93,900 2313.93,.0 1,"DT")
12854	3080529
12855	"^DD",9002 313.93,900 2313.93,.0 2,0)
12856	EXPLANATIO N^F^^0;2^K :$L(X)>70! ($L(X)<1) X
12857	"^DD",9002 313.93,900 2313.93,.0 2,3)
12858	Enter the descriptio n of the r eject code .
12859	"^DD",9002 313.93,900 2313.93,.0 2,21,0)
12860	^^1^1^3080 529^
12861	"^DD",9002 313.93,900 2313.93,.0 2,21,1,0)
12862	Textual ex planation of the cla im rejecti on.
12863	"^DD",9002 313.93,900 2313.93,.0 2,"DT")
12864	3080529
12865	"^DIC",900 2313.25,90 02313.25,0 )
12866	BPS NCPDP CLARIFICAT ION CODES^ 9002313.25
12867	"^DIC",900 2313.25,90 02313.25,0 ,"GL")
12868	^BPS(90023 13.25,
12869	"^DIC",900 2313.25,90 02313.25," %",0)
12870	^1.005^^0
12871	"^DIC",900 2313.25,90 02313.25," %D",0)
12872	^^6^6^3080 521^
12873	"^DIC",900 2313.25,90 02313.25," %D",1,0)
12874	This file is used to store the possible NCPDP CLAR IFICATION CODES valu es,
12875	"^DIC",900 2313.25,90 02313.25," %D",2,0)
12876	which are used for o verriding DUR reject s. No loc al changes should ev er
12877	"^DIC",900 2313.25,90 02313.25," %D",3,0)
12878	be made to this file . The dat a stored i n this fil e are base d on the
12879	"^DIC",900 2313.25,90 02313.25," %D",4,0)
12880	NCPDP stan dards and are nation ally distr ibuted.
12881	"^DIC",900 2313.25,90 02313.25," %D",5,0)
12882
12883	"^DIC",900 2313.25,90 02313.25," %D",6,0)
12884	Per VHA Di rective 20 04-038, th is file de finition s hould not be modifie d.
12885	"^DIC",900 2313.25,"B ","BPS NCP DP CLARIFI CATION COD ES",900231 3.25)
12886
12887	"^DIC",900 2313.91,90 02313.91,0 )
12888	BPS NCPDP FIELD DEFS ^9002313.9 1
12889	"^DIC",900 2313.91,90 02313.91,0 ,"GL")
12890	^BPSF(9002 313.91,
12891	"^DIC",900 2313.91,90 02313.91," %",0)
12892	^1.005^^0
12893	"^DIC",900 2313.91,90 02313.91," %","B","AB SP",1)
12894
12895	"^DIC",900 2313.91,90 02313.91," %D",0)
12896	^1.001^4^4 ^3100925^^ ^^
12897	"^DIC",900 2313.91,90 02313.91," %D",1,0)
12898	The NCPDP Data Dicti onary Indi vidual fie lds which combine in to formatt ed
12899	"^DIC",900 2313.91,90 02313.91," %D",2,0)
12900	packets.
12901	"^DIC",900 2313.91,90 02313.91," %D",3,0)
12902
12903	"^DIC",900 2313.91,90 02313.91," %D",4,0)
12904	Per VHA Di rective 20 04-038, th is file de finition s hould not be modifie d.
12905	"^DIC",900 2313.91,"B ","BPS NCP DP FIELD D EFS",90023 13.91)
12906
12907	"^DIC",900 2313.93,90 02313.93,0 )
12908	BPS NCPDP REJECT COD ES^9002313 .93
12909	"^DIC",900 2313.93,90 02313.93,0 ,"GL")
12910	^BPSF(9002 313.93,
12911	"^DIC",900 2313.93,90 02313.93," %",0)
12912	^1.005^^0
12913	"^DIC",900 2313.93,90 02313.93," %","B","AB SP",1)
12914
12915	"^DIC",900 2313.93,90 02313.93," %D",0)
12916	^1.001^8^8 ^3100817^^
12917	"^DIC",900 2313.93,90 02313.93," %D",1,0)
12918	NCPDP fiel d 511-FB R EJECT CODE
12919	"^DIC",900 2313.93,90 02313.93," %D",2,0)
12920
12921	"^DIC",900 2313.93,90 02313.93," %D",3,0)
12922	This file is used to store the possible NCPDP REJE CT CODES, that can b e
12923	"^DIC",900 2313.93,90 02313.93," %D",4,0)
12924	returned b y the paye r. No loc al changes should ev er be made to this
12925	"^DIC",900 2313.93,90 02313.93," %D",5,0)
12926	file. The data stor ed in this file are based on t he NCPDP s tandards a nd
12927	"^DIC",900 2313.93,90 02313.93," %D",6,0)
12928	are nation ally distr ibuted.
12929	"^DIC",900 2313.93,90 02313.93," %D",7,0)
12930
12931	"^DIC",900 2313.93,90 02313.93," %D",8,0)
12932	Per VHA Di rective 20 04-038, th is file de finition s hould not be modifie d.
12933	"^DIC",900 2313.93,"B ","BPS NCP DP REJECT CODES",900 2313.93)
12934
12935	"BLD",1045 8,6)
12936	8^
12937	END
12938	END
12939
12940
		12941
		12942
		12943
		12944
		12945
		12946
		12947
		12948
		12949
		12950
		12951
		12952