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Global: ^ABSPEI

Package: Pharmacy Point of Sale

Global: ^ABSPEI


Information

FileMan FileNo FileMan Filename Package
9002313.4 ABSP INSURER Pharmacy Point of Sale

Description

Directly Accessed By Routines, Total: 35

Package Total Routines
Pharmacy Point of Sale 35 ABSP5B1D    ABSPDB1D    ABSPECA1    ABSPECA8    ABSPECP1    ABSPECX1    ABSPER10    ABSPICNV
ABSPICPY    ABSPOS03    ABSPOS25    ABSPOS26    ABSPOS32    ABSPOS6L    ABSPOSC2    ABSPOSC4
ABSPOSCC    ABSPOSCG    ABSPOSFC    ABSPOSII    ABSPOSJ2    ABSPOSM    ABSPOSMF    ABSPOSMG
ABSPOSMH    ABSPOSN6    ABSPOSQ2    ABSPOSQ4    ABSPOSQA    ABSPOSQF    ABSPOSQG    ABSPOSQP
ABSPOSQQ    ABSPOSR7    ABSPOSS2    

Accessed By FileMan Db Calls, Total: 16

Package Total Routines
Pharmacy Point of Sale 15 ABSP5B1    ABSP5B2    ABSPDB1    ABSPDB2    ABSPICNV    ABSPOS03    ABSPOSC2    ABSPOSCC
ABSPOSCG    ABSPOSMF    ABSPOSMH    ABSPOSR5    ABSPOSR7    ABSPOSS    ABSPOSUU    
IHS Changes To Pharmacy 1 APSQPINS    

Pointed To By FileMan Files, Total: 5

Package Total FileMan Files
Pharmacy Point of Sale 5 ABSP CERTIFICATION(#9002313.31)[.04]    ABSP CLAIMS(#9002313.02)[.02]    ABSP ELIGIBILITY(#9002313.7)[.02]    ABSP TRANSACTION(#9002313.59)[803]    ABSP LOG OF TRANSACTIONS(#9002313.57)[803]    

Pointer To FileMan Files, Total: 6

Package Total FileMan Files
Pharmacy Point of Sale 5 ABSP PRICING TABLES(#9002313.53)[100.06]    ABSP DIAL OUT(#9002313.55)[100.07]    ABSP NCPDP FIELD DEFS(#9002313.91)[#9002313.42(.01), #9002313.46(.01)]    ABSP NCPDP FORMATS(#9002313.92)[100.01]    ABSP TRANSACTION(#9002313.59)[101.06]    
Utility Tables 1 INSURER(#9999999.18)[.01]    

Fields, Total: 51

Field # Name Loc Type Details
.01 NAME 0;1 POINTER TO INSURER FILE (#9999999.18)
************************REQUIRED FIELD************************
INSURER(#9999999.18)

  • INPUT TRANSFORM:  SET DINUM=X
  • LAST EDITED:  APR 13, 2010
  • AUDIT:  EDITED OR DELETED
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  9002313.4^B
    1)= S ^ABSPEI("B",$E(X,1,30),DA)=""
    2)= K ^ABSPEI("B",$E(X,1,30),DA)
100.01 RX - NCPDP Record Format 100;1 POINTER TO ABSP NCPDP FORMATS FILE (#9002313.92) ABSP NCPDP FORMATS(#9002313.92)

  • INPUT TRANSFORM:  S DIC("S")="I DUZ(0)[""@""!(($P(^(1),U,6)=1!($P(^(1),U,6)=3))&($P(^(1),U,7)'=1))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  DEC 13, 2011
  • SCREEN:  S DIC("S")="I DUZ(0)[""@""!(($P(^(1),U,6)=1!($P(^(1),U,6)=3))&($P(^(1),U,7)'=1))"
  • EXPLANATION:  Programmer may select any. Others must select a format that's in either Production or Field Testing.
  • AUDIT:  EDITED OR DELETED
  • CROSS-REFERENCE:  9002313.4^AFormat
    1)= S ^ABSPEI("AFormat",$E(X,1,30),DA)=""
    2)= K ^ABSPEI("AFormat",$E(X,1,30),DA)
100.02 RX - Dispensing Fee 100;2 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99.99)!(X<0) X
  • LAST EDITED:  APR 13, 2010
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 99.99, 2 Decimal Digits
  • AUDIT:  EDITED OR DELETED
100.03 RX - Activation Date 100;3 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUL 24, 1995
100.04 RX - # Days Backbill 100;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUL 24, 1995
  • HELP-PROMPT:  Type a Number between 1 and 999, 0 Decimal Digits
100.05 RX - Help Telephone # 100;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  APR 13, 2010
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • AUDIT:  EDITED OR DELETED
100.06 RX - PRICING METHOD 100;6 POINTER TO ABSP PRICING TABLES FILE (#9002313.53) ABSP PRICING TABLES(#9002313.53)

  • LAST EDITED:  APR 13, 2010
  • AUDIT:  EDITED OR DELETED
  • CROSS-REFERENCE:  9002313.4^APricing
    1)= S ^ABSPEI("APricing",$E(X,1,30),DA)=""
    2)= K ^ABSPEI("APricing",$E(X,1,30),DA)
    used by file 9002313.53 field .99
100.07 RX - DIAL OUT TO 100;7 POINTER TO ABSP DIAL OUT FILE (#9002313.55) ABSP DIAL OUT(#9002313.55)

  • LAST EDITED:  APR 13, 2010
  • AUDIT:  EDITED OR DELETED
  • CROSS-REFERENCE:  9002313.4^ADialOut
    1)= S ^ABSPEI("ADialOut",$E(X,1,30),DA)=""
    2)= K ^ABSPEI("ADialOut",$E(X,1,30),DA)
    used by file 9002313.55 computed field .99
100.08 GRACE PERIOD 100;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  APR 13, 2010
  • HELP-PROMPT:  Type a Number between 0 and 99999, 0 Decimal Digits
  • DESCRIPTION:  
    # of days beyond expiration - used by ABSPOS25 - see 9002313.99 field 951 for more details about how this works
  • AUDIT:  EDITED OR DELETED
100.09 NCPDP FORM - PRINT DRUG NAME 100;9 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  APR 13, 2010
  • DESCRIPTION:  
    Some insurance companies are asking that the drug name be printed.  We'll squeeze it onto the NCPDP form somehow. Set this flag for any such company.
  • AUDIT:  EDITED OR DELETED
100.11 NCPDP FORM - PRINT DIAGNOSIS 100;11 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  APR 13, 2010
  • DESCRIPTION:  
    Like NCPDP FORM - PRINT DRUG NAME
  • AUDIT:  EDITED OR DELETED
100.12 NCPDP FORM - PHARM # TO USE 100;12 SET
  • '0' FOR NABP #;
  • '1' FOR TAX ID #;
  • '2' FOR SPECIAL #;

  • LAST EDITED:  APR 13, 2010
  • AUDIT:  EDITED OR DELETED
100.13 NCPDP FORM - PRINT TAX ID # 100;13 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  APR 13, 2010
  • DESCRIPTION:  
    Refers to printing the tax id # above the pharmacy #.  Do not confuse with PHARM # TO USE and the tax id # there - it referes to printing the tax id # in lieu of the pharmacy #.
  • AUDIT:  EDITED OR DELETED
100.14 INSURER NPI FLAG 100;14 SET
  • '0' FOR NEITHER;
  • '1' FOR BOTH;
  • 'P' FOR PHARMACY ONLY;
  • 'D' FOR PRESCRIBER ONLY;

  • LAST EDITED:  APR 13, 2010
  • AUDIT:  EDITED OR DELETED
100.15 NCPDP VERSION 100;15 SET
************************REQUIRED FIELD************************
  • '1' FOR 5.1;
  • '2' FOR D.0;

  • LAST EDITED:  JUL 01, 2011
100.16 BIN NUMBER 100;16 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>6!($L(X)<6) X
  • LAST EDITED:  FEB 07, 2011
  • HELP-PROMPT:  Answer must be 6 characters in length
100.17 PCN NUMBER 100;17 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  FEB 07, 2011
  • HELP-PROMPT:  Answer must be 1-10 characters in length
100.18 MEDICARE PARTD? 100;18 SET
************************REQUIRED FIELD************************
  • '0' FOR N;
  • '1' FOR Y;

  • LAST EDITED:  FEB 28, 2011
100.19 Maximum RX's Per Claim 100;19 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  JUN 23, 2011
  • HELP-PROMPT:  Type a number between 1 and 99, 0 Decimal Digits
100.2 Add Disp. Fee to Ingr. Cost 100;20 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  FEB 28, 2011
100.3 *Contract Required 100;21 SET
  • '1' FOR YES;
  • '0' FOR NO;
  • 'U' FOR UNK;
  • 'D' FOR DONE;

  • LAST EDITED:  FEB 28, 2011
100.4 Total exclusive of Patient Amt UNBILLABLE OTC;2 SET
  • '1' FOR Y;
  • '0' FOR N;

  • LAST EDITED:  FEB 28, 2011
100.97 RX - DIAL OUT TO, RESOLVED COMPUTED

  • MUMPS CODE:  S X=$P($G(^ABSPEI(D0,100)),U,7) S:X="" X=$P($G(^ABSP(9002313.99,1,"DIAL-OUT DEFAULT")),U) S:X X=$P($G(^ABSP(9002313.55,X,0)),U)
  • ALGORITHM:  S X=$P($G(^ABSPEI(D0,100)),U,7) S:X="" X=$P($G(^ABSP(9002313.99,1,"DIAL-OUT DEFAULT")),U) S:X X=$P($G(^ABSP(9002313.55,X,0)),U)
100.99 NCPDP FORM - ANY SET COMPUTED

  • MUMPS CODE:  S X=$P($G(^ABSPEI(D0,100)),U,9,13)'?."^"
  • ALGORITHM:  S X=$P($G(^ABSPEI(D0,100)),U,9,13)'?."^"
101.01 RX SLEEPING UNTIL 101;1 DATE

  • INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 21, 2000
  • DESCRIPTION:  Fields 101.* are used in the case of a response with rejection because of host not available, host not responding, etc. - that is, when the insurer's system is purposefully not processing claims, like when Alaska Medicaid
    shuts down overnight.   We reschedule the claims for later retry.
101.02 RX SLEEP WAIT BASE 101;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>86400)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 21, 2000
  • HELP-PROMPT:  Type a Number between 1 and 86400, 0 Decimal Digits
  • DESCRIPTION:  
    Number of seconds to wait after the first time we discover the insurer is asleep.
101.03 RX SLEEP WAIT MULT 101;3 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>10)!(X<1)!(X?.E1"."4N.N) X
  • LAST EDITED:  JUN 21, 2000
  • HELP-PROMPT:  Type a Number between 1 and 10, 3 Decimal Digits
  • DESCRIPTION:  
    Each time the retry discovers the insurer is still asleep, multiple the wait time by this much for the next wait.
101.04 RX SLEEP WAIT MAX 101;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>86400)!(X<300)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 21, 2000
  • HELP-PROMPT:  Type a Number between 300 and 86400, 0 Decimal Digits
  • DESCRIPTION:  
    Maximum number of seconds to allow the rx sleep wait interval (101.05) to grow to.
101.05 RX SLEEP WAIT CURR 101;5 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>86400)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 21, 2000
  • HELP-PROMPT:  Type a Number between 1 and 86400, 0 Decimal Digits
  • DESCRIPTION:  
    Current value of the sleep wait timer.  (Expected expiry time is in 101.01)
101.06 RX SLEEP PROBER 101;6 POINTER TO ABSP TRANSACTION FILE (#9002313.59) ABSP TRANSACTION(#9002313.59)

  • LAST EDITED:  SEP 14, 2000
  • DESCRIPTION:  ABSPOSQ2 - when insurer is asleep, only one claim at a time is allowed to probe whether the insurer has awakened. This is that claim. All others have to stay in status 31 until the insurer is known to be awakened. This
    is done to * avoid sending lots of redundant, rejected claims during the sleep time * avoid constructing wasteful 9002313.02 entries (and .03 responses)
    for repetitive rejections
101.0799 REJECT SLEEP OVERRIDE 101;7 SET
  • '1' FOR Y;
  • '0' FOR N;

  • LAST EDITED:  JUL 25, 2003
  • DESCRIPTION:  A rejection code of 99 from an insurer/processor usually indicates the insurer/processor is not processing claims. When POS sees the rejection of 99, it puts the POS insurer in a "sleep" mode, waking at predefined times
    to "probe" the insurer to see if they are accepting claims again.  Unfortunately, several insurers starting sending the 99 to indicate that the patient was not a member of their plan (???) - this put the insurer in a
    permanent sleep state.  This switch will allow us to indentify those insurers that we want to continue to send claims to, even when we have received the 99 rejection.  (FYI, the sleep mode was an effort to avoid
    unnecessary traffic and cost incurred when claims are sent and the insurer is unable to process.)
  • TECHNICAL DESCR:  This override switch will be checked in ABSPOSQ4 in the REJSLEEP subroutine. When a "y" is detected in this field for a particular insurer, we will NOT put the insurer to sleep, even when a 99 is returned in the rejection
    field.
102.01 RX POSTAGE ALLOWED 102;1 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  APR 13, 2010
  • DESCRIPTION:  
    Does this insurer accept postage charges via POS claims?
  • AUDIT:  EDITED OR DELETED
102.02 RX POSTAGE POS LIMIT 102;2 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>100)!(X<0) X
  • LAST EDITED:  APR 13, 2010
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 100, 2 Decimal Digits
  • DESCRIPTION:  
    Alaska Medicaid, for example, only allows POS postage claims for up to $15.
  • AUDIT:  EDITED OR DELETED
102.03 RX SUPPLIES POSTAGE ALLOWED 102;3 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  APR 13, 2010
  • DESCRIPTION:  
    The insurer might accept POS claims for postage for prescriptions, but are POS claims for postage for supplies allowed?
  • AUDIT:  EDITED OR DELETED
103.01 RX SUPPLIES ALLOWED 103;1 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  APR 13, 2010
  • DESCRIPTION:  
    Does the insurer accept POS claims for supply items (as opposed to prescription drugs?)
  • AUDIT:  EDITED OR DELETED
104.01 RX PRIORITY 104;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>1000)!(X<-1000)!(X?.E1"."3N.N) X
  • LAST EDITED:  APR 13, 2010
  • HELP-PROMPT:  Type a Number between -1000 and 1000, 2 Decimal Digits
  • DESCRIPTION:  When there are multiple private insurances and the insurance selection program is trying to choose among them, and none of the standard rules produce any distinction, the program will choose the most recently added
    insurance from the patient's record as the first one.
    BUT... if you want to give special preference to a particular insurer, such as a specific pharmacy insurance, use this setting.  The higher number will have higher priority in order to break the tie.  For example, you
    might set PAID PRESCRIPTIONS to 8.
  • AUDIT:  EDITED OR DELETED
105.01 PREBILL - WHICH FORM 105;1 SET
  • '60.13' FOR NCPDP;
  • '60' FOR UB92;
  • '60.2' FOR 1500;

  • LAST EDITED:  APR 13, 2010
  • DESCRIPTION:  If this insurer's pharmacy bills should be printed on a different form from the system-wide default, then put the billing items field number of the appropriate pre-bill list here. Example: 60.2 for a 1500,
    60 for a UB92, 60.13 for an NCPDP form.
  • AUDIT:  EDITED OR DELETED
105.02 PREBILL - FORM FOR ROLLOVERS 105;2 SET
  • '60.13' FOR NCPDP;
  • '60' FOR UB92;
  • '60.2' FOR 1500;

  • LAST EDITED:  APR 13, 2010
  • DESCRIPTION:  
    Rollovers are different - if you are rolling over a claim after a partial payment (or denial?) from a previous insurer, maybe it goes on a different form?
  • AUDIT:  EDITED OR DELETED
105.99 PREBILL - ANY SET COMPUTED

  • MUMPS CODE:  S X=$G(^ABSPEI(D0,105))'?."^"
  • ALGORITHM:  S X=$G(^ABSPEI(D0,105))'?."^"
107.01 WORKERS COMP INSURANCE 107;1 SET
  • 'ONLY' FOR USE ONLY FOR WORKERS COMP;
  • 'BOTH' FOR BOTH WORKERS COMP AND NON-WC;
  • 'NEVER' FOR NEVER USE FOR WORKERS COMP;

  • LAST EDITED:  APR 13, 2010
  • DESCRIPTION:  
    Insurance handling may vary depending on whether this is a workers comp- covered visit.  This field tells you whether the insurance should be used only for workers comp, never for workers comp, or both cases.
  • AUDIT:  EDITED OR DELETED
200 ICD10 EFF DATE ICD10;1 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  NOV 06, 2012
  • HELP-PROMPT:  (No range limit on date)
201 STRIP DECIMAL POINT ICD10;2 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  OCT 18, 2017
  • HELP-PROMPT:  THIS WILL STRIP THE DECIMAL POINT FROM NCPDP D.0 TRANSMISSIONS
  • DESCRIPTION:  
    THIS FLAG WILL DETERMINE WHETHER OR NOT THE DECIMAL POINT SHOULD BE STRIPPED FROM THE NCPDP SEGMENT #424 DURING ELECTRONIC CLAIMS TRANSMISSION.
210 NCPDP FIELD SPECIAL CODE 210;0 POINTER Multiple #9002313.42 9002313.42
215 SUPPRESS NCPDP SEGMENT 221;0 SET Multiple #9002313.48 9002313.48
220 SUPPRESS NCPDP FIELD 220;0 POINTER Multiple #9002313.46 9002313.46
228.11 BILLABLE NDC # BILLABLE NDC #;0 Multiple #9002313.41 9002313.41
228.12 BILLABLE DRUG NAME BILLABLE DRUG NAME;0 WORD-PROCESSING #9002313.44
2128.11 UNBILLABLE NDC # UNBILLABLE NDC #;0 Multiple #9002313.43 9002313.43
2128.12 UNBILLABLE DRUG NAME UNBILLABLE DRUG NAME;0 WORD-PROCESSING #9002313.45
2128.13 UNBILLABLE OTC UNBILLABLE OTC;1 SET
  • '1' FOR OTC DRUGS ARE UNBILLABLE;
  • '0' FOR OTC DRUGS ARE BILLABLE;

  • LAST EDITED:  APR 13, 2010
  • DESCRIPTION:  
    This field can be used to override the system-wide setting for whether OTC drugs are billable.
  • AUDIT:  EDITED OR DELETED
2128.99 ANY UN/BILLABLES SET COMPUTED

  • MUMPS CODE:  S X=$$ANYSET^ABSPOSQQ(D0)
  • ALGORITHM:  S X=$$ANYSET^ABSPOSQQ(D0)
  • LAST EDITED:  NOV 10, 2000
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