28
M/I Date RX Written
|
4860
|
B
|
Date prescribed is invalid
|
D
|
D
|
D
|
D
|
|
|
|
28
|
M/I Date RX Written
|
4046
|
B
|
The date prescription written is greater than the date of service.
|
D
|
D
|
D
|
D
|
|
|
|
29
|
M/I # Refills Authorized
|
4047
|
B
|
The drug is a schedule two drug and the number of refills authorized is greater zero.
|
D
|
D
|
D
|
D
|
|
|
|
29
|
M/I # Refills Authorized
|
4425
|
C
|
The drug is a schedule zero and the number of refills authorized is greater than 11.
|
D
|
D
|
D
|
D
|
|
|
|
29
|
M/I # Refills Authorized
|
4426
|
C
|
The drug is a schedule 3, 4 or 5 and the number of refills authorized is greater than 5.
|
D
|
D
|
D
|
D
|
|
|
|
3A
|
M/I Request Type
|
4048
|
B
|
Missing/Invalid Request Type – 5.1 Only
The 5.1 transaction code equal P1-P4 and the request type on the PA transaction is missing or not equal to one of the valid values specified.
|
D
|
D
|
D
|
D
|
|
|
|
3B
|
M/I Request Period Date-Begin
|
4049
|
B
|
Missing Request Period Date-Begin – 5.1 Only
The Request Period Date-Begin is missing (zeros).
|
B
|
B
|
B
|
B
|
|
|
|
3C
|
M/I Request Period Date-End
|
4050
|
B
|
Missing Request Period Date-End – 5.1 Only
The Request Period Date-End is missing (zeros)
|
B
|
B
|
B
|
B
|
|
|
|
3D
|
M/I Basis Of Request
|
4051
|
B
|
Missing/Invalid Basis Of Request – 5.1 Only
The Basis Of Request is missing (spaces) or it does not match one of the valid values specified for the field.
|
B
|
B
|
B
|
B
|
|
|
|
3E
|
M/I Authorized Representative First Name
|
4052
|
B
|
M/I Authorized Representative First Name
|
B
|
B
|
B
|
B
|
|
|
|
3F
|
M/I Authorized Representative Last Name
|
4053
|
B
|
M/I Authorized Representative Last Name
|
B
|
B
|
B
|
B
|
|
|
|
3G
|
M/I Authorized Representative Street Address
|
4920
|
B
|
M/I Authorized Representative Street Address
|
B
|
B
|
B
|
B
|
|
|
|
3H
|
M/I Authorized Representative City Address
|
4921
|
B
|
M/I Authorized Representative City Address
|
B
|
B
|
B
|
B
|
|
|
|
3J
|
M/I Authorized Representative State/Province Address
|
4922
|
B
|
M/I Authorized Representative State/Province Address
|
B
|
B
|
B
|
B
|
|
|
|
3K
|
M/I Authorized Representative Zip/Postal Zone
|
4923
|
B
|
M/I Authorized Representative Zip/Postal Zone
|
B
|
B
|
B
|
B
|
|
|
|
3M
|
Prescriber Phone Number
|
4054
|
B
|
Prescriber Phone Number
|
B
|
B
|
B
|
B
|
|
|
|
3N
|
M/I Prior Authorized Number Assigned
|
4055
|
B
|
Missing Prior Authorization Number Assigned – 5.1 Only
The Prior Authorization Number Assigned is missing (zeros).
|
B
|
B
|
B
|
B
|
|
|
|
3P
|
M/I Authorization Number
|
4056
|
B
|
Missing Authorization Number – 5.1 Only
The Authorization Number is missing (spaces).
|
B
|
B
|
B
|
B
|
|
|
|
3R
|
Prior Authorization Not Required
|
4924
|
B
|
Prior Authorization Not Required
|
B
|
B
|
B
|
B
|
|
|
|
3S
|
M/I Prior Authorization Supporting Documentation
|
4057
|
B
|
M/I Prior Authorization Supporting Documentation
|
B
|
B
|
B
|
B
|
|
|
|
3T
|
Active Prior Authorization Exists Resubmit At Expiration Of Prior Authorization
|
4058
|
B
|
Active Prior Authorization Exists Resubmit At Expiration Of Prior Authorization
|
B
|
B
|
B
|
B
|
|
|
|
3W
|
Prior Authorization In Process
|
4059
|
B
|
Prior Authorization In Process – 5.1 Only
An inquiry was made on a Prior Authorization that was in “Pending” Status.
|
B
|
B
|
B
|
B
|
|
|
|
3X
|
Authorization Number Not Found
|
4060
|
B
|
Authorization Number Not Found – 5.1 Only
An inquiry or a reversal was made on a Prior Authorization that could not be found.
|
B
|
B
|
B
|
B
|
|
|
|
3Y
|
Prior Authorization Denied
|
4061
|
B
|
Prior Authorization Denied – 5.1 Only
An inquiry was made on a Prior Authorization that was in “Pending” Status.
|
B
|
B
|
B
|
B
|
|
|
|
30
|
M/I PA Med Cert #
|
4068
|
B
|
THE CLAIM IS VERSION 3.2 AND THE PRIOR AUTHORIZATION TYPE CODE(DRUG CERT CODE) IS NOT A VALID VALUE.
|
D
|
D
|
D
|
D
|
|
|
|
32
|
M/I Level of Service
|
4756
|
B
|
Client Specific Edit (IN)
Post edit if not valid value:
00=Not Specified
01=Patient Consultation
02=Home Delivery
03=Emergency
04=24 Hour Service
05=Patient Consultation About Generic Product Selection
|
D
|
D
|
D
|
D
|
|
|
|
32
|
M/I Level of Service
|
4961
|
C
|
Edit posted for: 1) illegal alliens; 2) non-aliens - override restricted card (lockin) and 3) non-aliens - emergency fills: level of srvc = 03 (emergency) and day supply is < 5
|
D
|
D
|
D
|
D
|
|
|
|
33
|
M/I RX Origin Code
|
4757
|
B
|
RX origin code missing or not a valid value
|
B
|
B
|
B
|
B
|
|
|
|
34
|
M/I Submission Clarification Code
|
4070
|
B
|
Invalid Submission Clarification Code
The Submission Clarification Code(drug RX override code) is not equal to valid values
|
B
|
B
|
B
|
B
|
|
|
|
35
|
M/I Primary Care Provider ID
|
4071
|
B
|
The Primary Care Provider ID is missing (spaces).
|
B
|
B
|
B
|
B
|
|
|
|
35
|
M/I Primary Care Provider ID
|
4072
|
B
|
The primary care provider qualifier is equal to DEA
AND
(The first two positions of primary care provider id is not alphabetic uppercase
OR
The last seven positions of the primary care provider id do not pass the check sum validation routine).
OR
The primary care provider qualifier is equal to Medicaid or UPIN or NCPDP or State License
|
