NCPDP Rejection Codes - PM
|
Error Code |
Description |
|
1 |
M/I Bin |
|
2 |
M/I Version Number |
|
3 |
M/I Transaction Code |
|
4 |
M/I Processor Control Number |
|
5 |
M/I Pharmacy Number |
|
7 |
M/I Cardholder ID Number |
|
12 |
M/I Patient Location |
|
13 |
M/I Other Coverage Code |
|
14 |
M/I Eligibility Clarification Code |
|
15 |
M/I Date of Service |
|
16 |
M/I Prescription/Service Reference Number |
|
17 |
M/I Fill Number |
|
19 |
M/I Days Supply |
|
20 |
M/I Compound Code |
|
21 |
M/I Product/Service ID |
|
22 |
M/I Dispense As Written/Product Selection Code |
|
23 |
M/I Ingredient Cost Submitted |
|
25 |
M/I Prescriber ID |
|
26 |
M/I Unit Of Measure |
|
28 |
M/I Date Prescription Written |
|
29 |
M/I Number Refills Authorized |
|
32 |
M/I Level Of Service |
|
33 |
M/I Prescription Origin Code |
|
34 |
M/I Submission Clarification Code |
|
40 |
Pharmacy Not Contracted With Plan On Date Of Service |
|
43 |
Plan prescriber database indicates the associated DEA to submitted Prescriber ID is inactive |
|
44 |
Plan's Prescriber database indicates the associated DEA to submitted Prescriber ID is not found |
|
67 |
|
|
70 |
Product not covered |
|
75 |
Prior Authorization Required |
|
76 |
Plan limitation exceeded |
|
79 |
Refill Too Soon |
|
80 |
Drug-Diagnosis Mismatch |
|
81 |
Claim Too Old |
|
82 |
Claim Is Post-Dated |
|
83 |
Duplicate Paid/Captured Claim |
|
84 |
Claim Has Not Been Paid/Captured |
|
87 |
Reversal Not Processed |
|
88 |
DUR Reject Error |
|
99 |
Host Processing Error |
|
201 |
BILLING PROVIDER ID NUMBER IS MISSING FROM CLAIM |
|
203 |
DATE OF SERVICE PRIOR TO CARD ISSUE DATE |
|
204 |
RECIPIENT ID NUMBER IS INVALID OR NOT FOUND ON CIS |
|
205 |
PRESCRIBING PRACTITIONER'S LICENSE NUMBER IS MISSING FROM THE CLAIM |
|
206 |
PRESCRIBING PRACTITIONER LICENSE NUMBER IS NOT IN A VALID FORMAT |
|
208 |
PREGNANCY INDICATOR INVALID |
|
209 |
CARD ISSUE INFORMATION NOT AVAILABLE |
|
210 |
BRAND MEDICALLY NECESSARY INDICATOR/DAW CODE INVALID |
|
214 |
DATE PRESCRIBED IS MISSING OR INVALID |
|
215 |
DATE DISPENSED IS MISSING |
|
216 |
DATE DISPENSED IS INVALID |
|
217 |
NDC MISSING |
|
218 |
NDC INVALID FORMAT |
|
219 |
QUANTITY DISPENSED IS MISSING |
|
220 |
QUANTITY DISPENSED IS INVALID |
|
221 |
DAYS SUPPLY MISSING |
|
222 |
DAYS SUPPLY INVALID |
|
227 |
THIRD PARTY PAYMENT AMOUNT INVALID |
|
231 |
PRESCRIPTION ORIGIN CODE IS INVALID |
|
247 |
MAXIMUM NUMBER OF CLAIM DETAILS EXCEEDED |
|
250 |
CLAIM HAS NO DETAILS |
|
264 |
THE DATE OF SERVICE IS MISSING |
|
265 |
THE DATE OF SERVICE IS INVALID |
|
268 |
BILLED AMOUNT MISSING |
|
269 |
BILLED AMOUNT INVALID |
|
270 |
TOTAL BILLED AMOUNT MISSING |
|
351 |
REFILL NOT ALLOWED FOR NARCOTIC DRUGS |
|
500 |
DATE PRESCRIBED AFTER BILLING DATE |
|
502 |
DATE DISPENSED EARLIER THAN DATE PRESCRIBED |
|
503 |
DATE DISPENSED AFTER BILLING DATE |
|
545 |
CLAIM PAST FILING LIMIT (DETAIL) |
|
554 |
BILLED DATE LESS THAN DATES OF SERVICE ON THE CLAIM |
|
613 |
|
|
619 |
Presciber Type 1 NPI required |
|
840 |
MISSING/INVALID PATIENT PAY FOR NCPDP |
|
846 |
SERVICE PROVIDER ID = ALL EIGHT'S THEN THIS FIELD |
|
871 |
DUR CANCELLATION/OVERRIDE- CANNOT BE LOCATED OR MUST BE SENT WITHIN 72 HOURS (verify that you are not sending DUR override information on the initial claim even though you expect a DUR alert. Override information cannot be submitted on the original claim. It can only be submitted once a DUR rejection is returned.) |
|
911 |
INTERNAL ERROR |
|
999 |
CIS UNAVAILABLE |
|
1015 |
DEA NUMBER NOT ON FILE - CONTACT PROVIDER ENROLLMENT |
|
1025 |
PRESCRIBING LICENSE NUMBER IS INVALID |
|
1032 |
BILLING PROVIDER NOT ELIGIBLE TO BILL THIS CLAIM TYPE |
|
1065 |
PROVIDER ENROLLED AS A BULK IMMUNIZATION PROVIDER |
|
1067 |
CRNP BILLING OR PRESCRIBING FOR CONTROLLED DRUGS AND THE DAYS SUPPLY EXCEEDS THE MAXIMUM LIMIT |
|
1139 |
NPI REPORTED FOR PRESCRIBING PROVIDER IS INVALID |
|
1152 |
NPI FOR BILLING ID IS INDICATED, BUT FORMAT INCORRECT |
|
1153 |
LEGACY FOR BILLING ID IS INDICATED, BUT FORMAT INCORRECT |
|
1154 |
NPI FOR PRESCRIBER ID IS INDICATED, BUT FORMAT INCORRECT |
|
1156 |
LICENSE# FOR PRESCRIBER ID IS INDICATED, BUT FORMAT INCORRECT |
|
1169 |
PRESCRIBING NPI REPORTED IS NOT AVAILABLE FOR USE |
|
2006 |
ALIEN ELIGIBLE FOR MEDICAL EMERGENCY ONLY |
|
2021 |
THE RECIPIENT'S CATEGORY IS NOT ELIGIBLE FOR NON-MEDICARE COVERED SERVICES |
|
2079 |
A MANUAL REVIEW IS REQUIRED TO VERIFY THE AGE OF THIS RECIPIENT |
|
2200 |
MEDICARE PART D COPAY IS NOT REIMBURSABLE |
|
2201 |
CLAIM BILLED FOR MEDICARE COPAY BILLED INCORRECTLY |
|
2524 |
NOT A MA COVERED DRUG FOR DUAL ELIGIBLE |
|
2527 |
DRUG REQUIRES PRIOR AUTH FOR DUAL ELIGIBLE |
|
2999 |
CLAIM REQUIRES MANUAL REVIEW BY THE DEPARTMENT |
|
3000 |
PA NUMBER INVALID FORMAT |
|
3002 |
NDC/PROCEDURE CODE REQUIRES PRIOR AUTHORIZATION WHICH IS NOT FOUND, MISSING, OR INVALID |
|
3004 |
EXISTING PA NOT VALID FOR DUAL ELIGIBLE |
|
3023 |
NDC NUMBER DOES NOT MATCH THE APPROVED COMBINATION FOR THIS PRIOR AUTHORIZATION |
|
3024 |
THE INVOICE CLAIM LINE QUANTITY EXCEEDS THE PRIOR AUTHORIZATION REQUEST QUANTITY |
|
3025 |
CLAIM DETAIL DATE OF SERVICE IS AFTER THE PRIOR AUTHORIZATION EXPIRATION DATE - DETAIL |
|
3026 |
THIS PROCEDURE CODE/MODIFIER- NDC OR PROGRAM EXCEPTION ON THE CLAIM DETAIL WAS DENIED ON YOUR PRIOR AUTHORIZATION REQUEST |
|
3028 |
THE PRESCRIBER LICENSE NUMBER DOES NOT MATCH THE PRESCRIBER LICENSE NUMBER ON THE PRIOR AUTHORIZATION REQUEST |
|
3035 |
OUR RECORDS INDICATE THE DEPT HAS ALREADY PAID FOR THIS CLAIM DETAIL PRIOR AUTHORIZATION INDICATED |
|
3041 |
DATE OF SERVICE IS BEFORE OR AFTER THE PA DATE |
|
4003 |
DRUG INDICATED HAS BEEN IDENTIFIED AS LESS THAN EFFECTIVE |
|
4007 |
ALL INGREDIENTS ARE NON-COVERED ON DOS |
|
4013 |
PROCEDURE CODE/NDC IS NOT COVERED FOR DATE OF SERVICE |
|
4021 |
RECIPIENT NOT ELIGIBLE FOR SERVICE PROVIDED |
|
4024 |
MAXIMUM NUMBER OF REFILLS HAS BEEN REACHED |
|
4026 |
THE NDC BILLED AND DAYS SUPPLY / QUANTITY DISPENSED ARE INCONSISTENT |
|
4075 |
MISSING/INVALID TRANSACTION COUNT |
|
4078 |
MISSING/INVALID OTHER COVERAGE CODE |
|
4079 |
MISSING/INVALID ELIGIBILITY CLARIFICATION CODE |
|
4080 |
PRILOSEC OTC EXCEEDS MAX QTY |
|
4081 |
PA REQUIRED FOR NON-PREFERRED PPI |
|
4082 |
PA REQUIRED >136 DAYS - HISTORY OF PPI |
|
4083 |
PA REQUIRED >136 OR >204 DAYS - NO HISTORY OF PPI |
|
4084 |
PA REQUIRED >340 DAYS OR >408 DAYS OF A PPI |
|
4086 |
MISSING/INVALID LEVEL OF SERVICE |
|
4088 |
PRIOR AUTHORIZATION REQUIRED FOR MORE THAN THREE TABLETS OF OXYCONTIN PER DAY |
|
4089 |
PRIOR AUTHORIZATION REQUIRED FOR MORE THAN TWO CONCURRENT STRENGTHS OF OXYCONTIN |
|
4090 |
REFILL TOO SOON - OXYCONTIN CLAIM |
|
4092 |
ANTI-ULCER TAKEN FOR MORE THAN 90 DAYS REQUIRES PA |
|
4093 |
PRILOSEC 10 MG EXCEEDS MAX QTY |
|
4094 |
MISSING/INVALID PRIOR AUTHORIZATION TYPE CODE |
|
4109 |
MISSING/INVALID PATIENT LOCATION CODE |
|
4144 |
NDC NOT COVERED ON DATE OF SERVICE FOR COMPOUND |
|
4147 |
RECIPIENT NUMBER NOT ON THE PRIOR AUTHORIZATION DATABASE |
|
4153 |
DRUG CODE FOR A PRE-NATAL VITAMIN WITH NO PREGNANCY INDICATOR |
|
4154 |
EMERGENCY QUANTITY CANNOT EXCEED A FIVE-DAY SUPPLY |
|
4156 |
RECIPIENT ONLY ELIGIBLE FOR BIRTH CONTROL DRUGS. |
|
4157 |
PRIOR AUTHORIZATION IS REQUIRED FOR EXCEPTIONS TO THE MONTHLY PRESCRIPTION LIMIT |
|
4158 |
REVERSAL INFORMATION DOES NOT MATCH A PREVIOUSLY APPROVED CLAIM |
|
4159 |
THIS CLAIM HAS ALREADY BEEN REVERSED |
|
4160 |
MORE THAN ONE CLAIM HAS BEEN APPROVED WHEN TRYING TO REVERSE A CLAIM |
|
4173 |
BRAND DRUG MEDICALLY NECESSARY |
|
4178 |
INVALID BIN NUMBER |
|
4179 |
INVALID NCPCP VERSION NUMBER |
|
4180 |
INVALID TRANSACTION CODE |
|
4181 |
INVALID PROCESSOR NUMBER |
|
4183 |
SERVICE PROVIDER ID QUALIFIER INVALID |
|
4184 |
INVALID SOFTWARE VENDOR CERTIFICATION ID |
|
4185 |
INVALID PATIENT SEGMENT IDENTIFIER |
|
4186 |
INVALID INSURANCE SEGMENT IDENTIFIER |
|
4187 |
INVALID CLAIM SEGMENT IDENTIFIER |
|
4188 |
INVALID RX/SERVICE REFERENCE NUMBER QUALIFIER |
|
4189 |
INVALID PRODUCT/SERVICE ID QUALIFIER |
|
4190 |
INVALID COMPOUND CODE |
|
4191 |
INVALID SUBMISSION CLARIFICATION CODE |
|
4192 |
INVALID UNIT OF MEASURE |
|
4193 |
INVALID PRESCRIBER SEGMENT IDENTIFIER |
|
4194 |
INVALID PRESCRIBER ID QUALIFIER |
|
4195 |
INVALID COB/OTHER PAYER SEGMENT IDENTIFIER |
|
4196 |
INVALID COB/OTHER PAYER COUNT |
|
4197 |
COB/OTHER PAYER COUNT DOES NOT MATCH ACTUAL |
|
4198 |
MISSING/INVALID OTHER PAYER COVERAGE TYPE |
|
4199 |
INVALID OTHER PAYER ID QUALIFIER |
|
4216 |
DUPLICATE OTHER PAYER COVERAGE TYPE |
|
4243 |
INVALID OTHER PAYER ICN SUBMITTED |
|
4266 |
DAILY DOSAGE EXCEEDS LIMIT FOR EMERGENCY CLAIM |
|
4267 |
DAILY DOSAGE EXCEEDED FOR NON-EMERGENCY CLAIM |
|
4300 |
MISSING/INVALID OTHER PAYER ID |
|
4301 |
MCO INACTIVE |
|
4302 |
MCO NOT ON FILE |
|
4303 |
OTHER PAYER DATE MISSING |
|
4304 |
OTHER PAYER DATE INVALID |
|
4305 |
INVALID OTHER PAYER COUNT |
|
4306 |
INVALID OTHER PAYER PAID AMOUNT QUALIFIER |
|
4307 |
OTHER PAYER PAID AMOUNT QUALIFIER FOR PRIMARY PAYER IS INVALID |
|
4308 |
OTHER PAYER PAID AMOUNT QUALIFIER FOR SECONDARY PAYER IS INVALID |
|
4309 |
OTHER PAYER PAID AMOUNT FOR PRIMARY PAYER ENCOUNTER IS INVALID |
|
4310 |
OTHER PAYER PAID AMOUNT FOR SECONDARY PAYER ENCOUNTER IS INVALID |
|
4311 |
INVALID OTHER PAYER REJECT COUNT |
|
4312 |
INVALID OTHER PAYER REJECT CODE |
|
4313 |
INVALID DUR/PPS SEGMENT IDENTIFIER |
|
4314 |
INVALID DUR/PPS CODE COUNTER |
|
4315 |
INVALID REASON FOR SERVICE CODE |
|
4316 |
INVALID PROFESSIONAL SERVICE CODE |
|
4317 |
MISSING/INVALID RESULT OF SERVICE CODE |
|
4318 |
INVALID PRICING SEGMENT IDENTIFIER |
|
4319 |
INVALID INGREDIENT COST SUBMITTED |
|
4320 |
INVALID BASIS OF COST DETERMINATION |
|
4321 |
INVALID COMPOUND SEGMENT IDENTIFIER |
|
4322 |
INVALID COMPOUND DISPENSING UNIT FORM INDICATOR |
|
4323 |
INVALID COMPOUND ROUTE OF ADMINISTRATION |
|
4324 |
MISSING/INVALID COMPOUND INGREDIENT COUNT |
|
4325 |
OVER MAXIMUM COMPOUND INGREDIENT COUNT |
|
4326 |
SUBMITTED COMPOUND INGREDIENT COUNT DOES NOT MATCH ACTUAL |
|
4327 |
INVALID COMPOUND PRODUCT ID QUALIFIER |
|
4328 |
INVALID COMPOUND INGREDIENT DRUG COST |
|
4329 |
INVALID COMPOUND INGREDIENT BASIS OF COST DETERMINATION |
|
4330 |
INVALID CLINICAL SEGMENT IDENTIFIER |
|
4331 |
INVALID DIAGNOSIS CODE COUNT |
|
4332 |
SUBMITTED DIAGNOSIS CODE COUNT DOES NOT MATCH ACTUAL |
|
4333 |
INVALID DIAGNOSIS CODE QUALIFIER |
|
4336 |
INVALID COMPOUND DOSAGE FORM |
|
4337 |
INVALID OTHER PAYER COUNT - ENCOUNTER |
|
4338 |
INVALID OTHER PAYER COVERAGE TYPE - ENCOUNTER |
|
4339 |
NDC NOT COVERED IN A NON COMPOUND CLAIM |
|
4340 |
NDC REQUIRES MANUAL REVIEW UNLESS ELIGIBILITY CLARIFICATION CODE |
|
4342 |
NO EMERGENCY SUPPLIES ALLOWED FOR THIS DRUG |
|
4343 |
ED DRUG NOT COVERED EFFECTIVE 3/1/2006 |
|
4416 |
VALIDATE THE NUMBER OF UNITS BILLED AND THE BILLED AMOUNT |
|
5002 |
EXACT DUPLICATE DRUG CLAIM SUBMITTED |
|
5005 |
GENERIC DUPLICATE DRUG CLAIM SUBMITTED |
|
5006 |
MAXIMUM NUMBER OF REFILLS HAS BEEN EXCEEDED FOR RX |
|
5021 |
SAME PROVIDER, SERVICE LOC, DOS & RX # IN HISTORY |
|
5031 |
SUPER PA REQ, MAX DAILY DOSE OF ED RX EXCEEDED |
|
5033 |
SUPER PA REQ, DDI WITH AN ED DRUG AND NITRATE |
|
5034 |
SUPER PA REQ, DDI WITH AN ED DRUG AND ALPHABLOCKER |
|
5035 |
SUPER PA REQ, CURRENT ED RX NOT SAME AS LAST ED RX |
|
5036 |
SUPER PA REQ, ED RX FOR RECIPIENT < 19 YEARS OLD |
|
5037 |
SUPER PA REQ, NO HISTORY OF ED PA OR PE |
|
5040 |
PA REQUIRED, EARLY REFILL OF A COX II RX |
|
5041 |
PA REQUIRED, THERAPY OF A COX II RX NOT CHANGED |
|
5042 |
PA REQUIRED, NO HISTORY OF A COX II RX |
|
5043 |
MAXIMUM QUANTITY LIMIT EXCEEDED FOR ANTI-NAUSEA |
|
5046 |
EARLY REFILL OF COX-II |
|
5047 |
COX-II DUPLICATIVE NSAID |
|
5048 |
COX-II CONCURRENT ANTI-COAGULANT |
|
5049 |
ANTI-ULCER DRUG REQUIRES PA |
|
5051 |
REFILL ON INVOICE IS OLDER THAN SIX MONTHS. |
|
5103 |
GA RECIPIENT LIMITED TO 6 PRESCRIPTIONS PER MONTH |
|
5136 |
PHARMACY AMOUNT EXCEEDS MAX |
|
5144 |
MAXIMUM DAILY DOSAGE EXCEEDED FOR COX II |
|
5145 |
MAXIMUM DAILY DOSAGE EXCEEDED FOR VIOXX |
|
5146 |
ED DRUGS LIMITED TO 4 PER MONTH |
|
5147 |
ED DRUGS LIMITED TO 6 PER MONTH |
|
5150 |
DAILY PAID AMOUNT EXCEEDS MAX |
|
5475 |
PA REQUIRED, DRUG IS NON-PREFERRED |
|
5478 |
PA REQUIRED, CHRONIC THERAPY OF PPI |
|
5481 |
PRIOR AUTH REQUIRED FOR THIS ANTICONVULSANT DRUG |
|
5482 |
PRIOR AUTH REQUIRED FOR SPIRIVA IF RECIP AGE < 45 |
|
5483 |
PRIOR AUTH REQUIRED FOR THIS HYPOGLYCEMIC DRUG |
|
5484 |
PA REQUIRED FOR COMTAN |
|
5918 |
CLAIM HAS NOT BEEN PAID/CAPTURED |
|
5919 |
SUPER PA REQUIRED FOR EXCEPTIONS TO GA PRESCRIPTION MAX |
|
7000 |
CLAIM FAILED A PRODUR ALERT |
|
7002 |
CLAIM FAILED A PRODUR ALERT FOR LATE REFILL |
|
7003 |
CLAIM FAILED A PRODUR ALERT FOR DRUG DRUG |
|
7004 |
CLAIM FAILED A PRODUR ALERT FOR THERAPEUTIC DUP |
|
7005 |
CLAIM FAILED A PRODUR ALERT FOR PREGNANCY |
|
7006 |
CLAIM FAILED A PRODUR ALERT FOR EARLY REFILL |
|
7007 |
CLAIM FAILED A PRODUR ALERT FOR HIGH DOSE |
|
7008 |
CLAIM FAILED A PRODUR ALERT FOR PEDIATRIC AGE |
|
7009 |
CLAIM FAILED A PRODUR ALERT FOR GERIATRIC AGE |
|
7010 |
CLAIM FAILED A PRODUR ALERT FOR LOW DOSE |
|
7011 |
CLAIM FAILED A PRODUR ALERT FOR MINIMUM DURATION |
|
7012 |
CLAIM FAILED A PRODUR ALERT FOR MAXIMUM DURATION |
|
7013 |
CLAIM FAILED A PRODUR ALERT FOR DRUG DISEASE |
|
7014 |
CLAIM FAILED A PRODUR ALERT FOR INGREDIENT DUP |
|
7016 |
DUR CANCELLATION PROCESSED |
|
7024 |
LTC, PRIVATE ICF/MR RECIPIENT - NONCOMPENSABLE DRUG |
|
7027 |
DRUG QUANTITY PER DAY LIMIT HAS BEEN EXCEEDED |
|
7100 |
DUR PLUS NON-PRD STATINS |
|
7101 |
DUR PLUS LIPITOR 80MG |
|
7102 |
DUR PLUS NON-PDL BENZO – AGE 0-20 |
|
7103 |
DUR PLUS PRD BENZO – AGE 0-20 |
|
7104 |
DUR PLUS NP BENZO – AGE GREATER THAN 21 |
|
7106 |
DUR PLUS NON-PRD ANTIHISTAMINE |
|
7107 |
DUR PLUS PRD OTC ANTIHISTAMINE FOR DUAL |
|
7108 |
DUR PLUS NON-PRD SSRI |
|
7109 |
DUR PLUS NON-PRD ORAL BETA-AGONIST |
|
7110 |
DUR PLUS NPD SHORT-ACTING BETA-AGONIST INH SOL |
|
7111 |
DUR PLUS NPD SHORT-ACTING BETA-AGONIST INHALERS |
|
7112 |
DUR PLUS NPD LONG-ACTING BETA-AGONIST INH SOL |
|
7113 |
DUR PLUS NON-PRD INTRANASAL RHINITIS |
|
7114 |
DUR PLUS PRD COSMETIC ACNE AGENTS |
|
7115 |
DUR PLUS NPD NON-COSMETIC ACNE AGENTS EXC COMBOS |
|
7116 |
DUR PLUS NPD COSMETIC ACNE AGENTS – AGE 0-20 |
|
7117 |
DUR PLUS NPD COSMETIC ACNE AGENTS – AGE 21-120 |
|
7118 |
DUR PLUS SPRIVIA |
|
7119 |
DUR PLUS NON-PRD NSAID (EXCLUDING CELEBREX) |
|
7120 |
DUR PLUS CELEBREX |
|
7121 |
DUR PLUS PRD NSAID |
|
7122 |
DUR PLUS RESTASIS |
|
7123 |
DUR PLUS SUBOXONE/SUBUTEX |
|
7124 |
DUR PLUS SUBOXONE CONTRAINDICATED MEDICATIONS |
|
7125 |
DUR PLUS NON-PRD STIMULANTS |
|
7126 |
DUR PLUS NON-PDL SUBOXONE CONTRAINDICATED MEDS |
|
7127 |
DUR PLUS NPD SUBOXONE CONTRAINDICATED |
|
7128 |
DUR PLUS NON-PDL BENZO – AGE 21-120 |
|
7129 |
DUR PLUS PRD BENZO – AGE 21-120 |
|
7130 |
DUR PLUS NPD BENZO – AGE 0-20 |
|
7131 |
DUR PLUS DAYTRANA |
|
7132 |
DUR PLUS LIQUADD |
|
7133 |
DUR PLUS NUVGIL |
|
7134 |
DUR PLUS PROVIGIL |
|
7135 |
DUR PLUS NPD PPI – AGE 6-120 |
|
7136 |
DUR PLUS PRD PPI – AGE 0-5 |
|
7137 |
DUR PLUS OTC PPI FOR DUAL |
|
7138 |
DUR PLUS NPD PPI – AGE 0-5 |
|
7139 |
DUR PLUS NPD DRUG – PRIOR AUGH REQUIRED |
|
7140 |
DUR PLUS NPD PANCRECARB MS |
|
7141 |
DUR PLUS NPD EVISTA |
|
7142 |
DUR PLUS SHORT-ACTING INHALER |
|
7143 |
DUR PLUS NPD INHALINATION SOLUTION |
|
7144 |
DUR PLUS NPD LONG-ACTING INHALER |
|
7145 |
DUR PLUS NPD SEREVENT |
|
7146 |
DUR PLUS NPD INTRANASAL RHINITIS |
|
7147 |
DUR PLUS NPD VERAMYST |
|
7148 |
DUR PLUS NPD PHENYTEK |
|
7149 |
DUR PLUS NPD FELBATOL |
|
7150 |
DUR PLUS NPD STAVZOR |
|
7151 |
DUR PLUS LYRICA |
|
7152 |
DUR PLUS PRD TOPAMAX/TOPIRAMATE |
|
7153 |
DUR PLUS SKELETAL MUSCLE RELAXANTS |
|
7154 |
DUR PLUS NPD AZASAN |
|
7155 |
DUR PLUS NPD CYCLOSPORINE |
|
7156 |
DUR PLUS MYFORTIC |
|
7157 |
DUR PLUS NPD TACROLIMUS |
|
7158 |
DUR PLUS NPD MULTIPLE SCLEROSIS |
|
7159 |
DUR PLUS REVATIO |
|
7160 |
DUR PLUS NPD ADCIRCA |
|
7161 |
DUR PLUS NPD PPI AGE 6-12 |
|
7162 |
DUR PLUS NPD PREV SOLU & PROTONIX SUSP – AGE 6-12 |
|
7163 |
DUR PLUS NPD SAVELLA |
|
7164 |
DUR PLUS CYMBALTA |
|
7165 |
DUR PLUS ZORTRESS |
|
7166 |
DUR PLUS NPD CHLORAL HYDRATE AGE 0-11 |
|
7167 |
DUR PLUS NON-PRD ANTIPARKINSON’S |
|
7168 |
DUR PLUS NON-PRD ACTONEL |
|
7169 |
DUR PLUS NON-PRD BONIVA |
|
7170 |
DUR PLUS NON-PRD BUDESONIDE/PULMICORT RE |
|
7181 |
DUR PLUS: PA REQ’D MOR THAN 1 BETA BLOCKE |
|
7182 |
DUR PLUS: PA REQ’D MORE THAN 1 CALC. CHAN |
|
7183 |
DUR PLUS: PA REQ’D MORE THAN 1 INH GLUCOCO |
|
7184 |
DUR PLUS: PA REQ’D MORE THAN 1 STATIN |
|
7185 |
DUR PLUS: PA REQ’D MORE THAN 1 LONG ACT. BE |
|
7186 |
DUR PLUS: PA REQ’D MORE THAN 1 LONG-ACT. NA |
|
7187 |
DUR PLUS: PA REQ’D MORE THAN 1 PPI |
|
7188 |
DUR PLUS: PA REQ’D MORE THAN 1 TRIPTAN |
|
7189 |
DUR PLUS: PA REQ’D MORE THAN 1 LONG-ACT STIMULANT |
|
7190 |
DUR PLUS: PA REQ’D MORE THAN 1 SHORT-ACT STIMULANT |
|
7191 |
DUR PLUS: PA REQ’D MORE THAN 1 SKEL. MUS. RELAXANT |
|
7192 |
DUR PLUS: PA REQ’D MORE THAN 1 NSAID |
|
7193 |
DUR PLUS: PA REQ’D GABAPENTIN + PREGABALIN |
|
7194 |
DUR PLUS NPD PPI AGE 6-120 |
|
7195 |
DUR PLUS NPD REVATIO AGE 0-17 |
|
7196 |
DUR PLUS NPD REVATIO AGE 18-120 |
|
7197 |
DUR PLUS ADCIRCA |
|
7198 |
DUR PLUS NPD CELLCEPT |
|
7199 |
DUR PLUS NPD TYVASO |
|
7200 |
DUR PLUS NPD HIV MEDICATION |
|
7201 |
DUR PLUS PROMETHAZINE AGE 0-5 |
|
7202 |
DUR PLUS NPD CEFDINIR CAPSULES AGE 0-17 |
|
7203 |
DUR PLUS NPD XIFAXAN 550MG |
|
7204 |
DUR PLUS ULCERATIVE COLITIS |
|
7205 |
DUR PLUS ADULT AGE EDIT, STIMULANTS AND RELATED |
|
7206 |
DUR PLUS AGE EDIT, ANTIPSYCHOTIC |
|
7207 |
DUR PLUS NP EQUETRO |
|
7208 |
DUR PLUS ORAL KETOROLAC |
|
7209 |
DUR PLUS INJECTABLE KETOROLAC AGE 2-16 |
|
7210 |
DUR PLUS INJECTABLE KETOROLAC AGE 17-120 |
|
7211 |
DUR PLUS INJECTABLE KETOROLAC AGE 0-1 |
|
7212 |
DUR PLUS NASAL KETOLOAC |
|
7213 |
DUR PLUS NP CHANTIX |
|
7500 |
BILLING PROVIDER ON PREPAYMENT REVIEW |
|
7501 |
RECIPIENT IS LOCKED-IN TO A SPECIFIC PROVIDER |
|
7506 |
CLAIM CONTAINS A NON-OVERRIDABLE ALERT |
|
7510 |
RECIPIENT LOCKED INTO A DIFFERENT PRESCRIBER |
|
2C |
M/I Pregnancy Indicator |
|
4C |
M/I Coordination Of Benefits/Other Payments Count |
|
5C |
M/I Other Payer Coverage Type |
|
5E |
M/I Other Payer Reject Count |
|
6C |
M/I Other Payer ID Qualifier |
|
6E |
M/I Other Payer Reject Code |
|
7C |
M/I Other Payer ID |
|
8R |
Submission Clarification Code NOT Supported |
|
9G |
|
|
A7 |
M/I Internal Control Number |
|
A9 |
M/I Transaction Count |
|
AB |
Date Written Is After Date Filled |
|
AD |
Billing Prov Not Eligible To Bill This Claim Type |
|
AK |
M/I Software Vendor/Certification ID |
|
B2 |
M/I Service Provider ID Qualifier |
|
DN |
M/I Basis Of Cost Determination |
|
DQ |
M/I Usual And Customary Charge |
|
DV |
M/I Other Payer Amount Paid |
|
DX |
M/I Patient Paid Amount Submitted |
|
E1 |
M/I Product/Service ID Qualifier |
|
E4 |
M/I Reason For Service Code |
|
E5 |
M/I Professional Service Code |
|
E6 |
M/I Result Of Service Code |
|
E7 |
M/I Quantity Dispensed |
|
E8 |
M/I Other Payer Date |
|
EC |
M/I Compound Ingredient Component Count |
|
EE |
M/I Compound Ingredient Drug Cost |
|
EF |
M/I Compound Dosage Form Description Code |
|
EG |
M/I Compound Dispensing Unit Form Indicator |
|
EH |
M/I Compound Route Of Administration |
|
EM |
M/I Prescription/Service Ref Number Qualifier |
|
EU |
M/I Prior Authorization Type Code |
|
EZ |
M/I Prescriber ID Qualifier |
|
HB |
M/I Other Payer Amount Paid Count |
|
HC |
M/I Other Payer Amount Paid Qualifier |
|
M1 |
Patient Not Covered In This Aid Category |
|
M2 |
Recipient Locked In |
|
M4 |
Prescription/Service Ref No/Time Limit Exceeded |
|
M5 |
Requires Manual Claim |
|
P3 |
Compound Ingred Count does not Match No of Reps |
|
P4 |
COB/TPL Count does not Match No of Reps |
|
P7 |
Diag Code Count Does Not Match No. Of Repetitions |
|
P8 |
DUR/PPS Code Counter Out Of Sequence |
|
PC |
M/I Claim Segment |
|
PD |
M/I Clinical Segment |
|
PE |
M/I COB/Other Payments Segment |
|
PF |
M/I Compound Segment |
|
PH |
M/I DUR/PPS Segment |
|
PJ |
M/I Insurance Segment |
|
PK |
M/I Patient Segment |
|
PN |
M/I Prescriber Segment |
|
PP |
M/I Pricing Segment |
|
RE |
M/I Compound Product ID Qualifier |
|
UE |
M/I Compound Ingred Basis Of Cost Determination |
|
VE |
M/I Diagnosis Code Count |
|
WE |
M/I Diagnosis Code Qualifier |