| FileMan FileNo | FileMan Filename | Package | 
|---|---|---|
| 9002313.02 | ABSP CLAIMS | Pharmacy Point of Sale | 
| Package | Total | FileMan Files | 
|---|---|---|
| Pharmacy Point of Sale | 4 | ABSP CERTIFICATION(#9002313.31)[.03] ABSP RESPONSES(#9002313.03)[.01] ABSP TRANSACTION(#9002313.59)[3, 401] ABSP LOG OF TRANSACTIONS(#9002313.57)[3, 401] | 
| Package | Total | FileMan Files | 
|---|---|---|
| Pharmacy Point of Sale | 1 | ABSP INSURER(#9002313.4)[.02] | 
| Field # | Name | Loc | Type | Details | 
|---|---|---|---|---|
| .01 | Claim ID | 0;1 | FREE TEXT | ************************REQUIRED FIELD************************ 
 | 
| .02 | Electronic Payor | 0;2 | POINTER TO ABSP INSURER FILE (#9002313.4) | ABSP INSURER(#9002313.4) 
 | 
| .03 | Billing Item IEN | 0;3 | POINTER ** TO AN UNDEFINED FILE ** | 
 | 
| .04 | Transmit Flag | 0;4 | SET | 
 
 | 
| .05 | Transmitted On | 0;5 | DATE | 
 | 
| .06 | Created On | 0;6 | DATE | 
 | 
| 1.01 | Patient Name | 1;1 | FREE TEXT | 
 | 
| 1.02 | Billing Item PCN # | 1;2 | FREE TEXT | 
 | 
| 1.03 | Billing Item VCN # | 1;3 | FREE TEXT | 
 | 
| 101 | BIN Number | 100;1 | FREE TEXT | 
 | 
| 102 | Version/Release Number | 100;2 | FREE TEXT | 
 | 
| 103 | Transaction Code | 100;3 | FREE TEXT | 
 | 
| 104 | Processor Control Number | 100;4 | FREE TEXT | 
 | 
| 109 | Transaction Count | 100;9 | FREE TEXT | 
 | 
| 110 | Software Vendor/Cert ID | 100;10 | FREE TEXT | 
 | 
| 147 | Pharmacy Service Type | 140;7 | NUMBER | 
 | 
| 201 | Service Provider ID | 200;1 | FREE TEXT | 
 | 
| 202 | Service Provider ID Qualifier | 200;2 | FREE TEXT | 
 | 
| 301 | Group ID | 300;1 | FREE TEXT | 
 | 
| 302 | Cardholder ID | 300;2 | FREE TEXT | 
 | 
| 303 | Person Code | 300;3 | FREE TEXT | 
 | 
| 304 | Date of Birth | 300;4 | FREE TEXT | 
 | 
| 305 | Patient Gender Code | 300;5 | FREE TEXT | 
 | 
| 306 | Patient Relationship Code | 300;6 | FREE TEXT | 
 | 
| 307 | Place of Service | 300;7 | FREE TEXT | 
 | 
| 308 | Other Coverage Code | 300;8 | FREE TEXT | 
 | 
| 309 | Eligibility Clarification Code | 300;9 | FREE TEXT | 
 | 
| 310 | Patient First Name | 300;10 | FREE TEXT | 
 | 
| 311 | Patient Last Name | 300;11 | FREE TEXT | 
 | 
| 312 | Cardholder First Name | 300;12 | FREE TEXT | 
 | 
| 313 | Cardholder Last Name | 300;13 | FREE TEXT | 
 | 
| 314 | Home Plan | 300;14 | FREE TEXT | 
 | 
| 315 | Employer Name | 300;15 | FREE TEXT | 
 | 
| 316 | Employer Street Address | 300;16 | FREE TEXT | 
 | 
| 317 | Employer City Address | 300;17 | FREE TEXT | 
 | 
| 318 | Employer State | 300;18 | FREE TEXT | 
 | 
| 319 | Employer Zip Code | 300;19 | FREE TEXT | 
 | 
| 320 | Employer Phone Number | 320;20 | FREE TEXT | 
 | 
| 322 | Patient Street Address | 321;2 | FREE TEXT | 
 | 
| 323 | Patient City Address | 321;3 | FREE TEXT | 
 | 
| 324 | Patient State/Prov Address | 321;4 | FREE TEXT | 
 | 
| 325 | Patient Zip/Postal Zone | 321;5 | FREE TEXT | 
 | 
| 326 | Patient Phone Number | 321;6 | FREE TEXT | 
 | 
| 327 | Carrier ID # | 320;27 | FREE TEXT | 
 | 
| 329 | Patient SSN | 320;29 | FREE TEXT | 
 | 
| 331 | Patient ID Qualifier | 330;1 | FREE TEXT | 
 | 
| 332 | Patient ID | 330;2 | FREE TEXT | 
 | 
| 333 | Employer ID | 330;3 | FREE TEXT | 
 | 
| 334 | Smoker/Non Smoker | 330;4 | FREE TEXT | 
 | 
| 335 | Pregnancy Indicator | 330;5 | FREE TEXT | 
 | 
| 336 | Facility ID | 330;6 | FREE TEXT | 
 | 
| 350 | Patient E-mail Address | 350;1 | FREE TEXT | 
 | 
| 384 | Patient Residence | 380;4 | NUMBER | 
 | 
| 388 | FACILITY CITY | 388;1 | FREE TEXT | 
 | 
| 390 | NARRATIVE MESSAGE | 390;1 | FREE TEXT | 
 | 
| 400 | Medication(s) | 400;0 | Multiple #9002313.0201 | 9002313.0201 
 | 
| 401 | Date of Service | 401;1 | FREE TEXT | 
 | 
| 498.09 | Authorized Rep State/Prov | 498;9 | FREE TEXT | 
 | 
| 524 | Plan ID | 520;4 | FREE TEXT | 
 | 
| 9999 | RAW DATA SENT | M;0 | WORD-PROCESSING #9002313.29999 |