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Pharmacy Claims File Submission

Utah

Versions: Pharmacy Claims File Submission• Pharmacy Claims File SubmissionCompare Versions


Name:Pharmacy Claims File Submission
State:Utah
Definition:Not Provided
VersionAugust 12, 2009 - v1.3

File Specification for Pharmacy Claims File Submission

Data Element ID Data Element Description Type Format Length
1 Payer Name Not Provided Not Provided 80
2 Insured Group or Policy Number Not Provided Not Provided 30
3 Subscriber Last name Subscriber / Policy Holder Information Not Provided 35
4 Subscriber First name Not Provided Not Provided 25
5 Subscriber Middle Name Name or Initial Not Provided 25
6 Subscriber Primary Identifier Not Provided Not Provided 80
7 Subscriber Address Not Provided Not Provided 55
8 Subscriber Address 2 Not Provided Not Provided 55
9 Subscriber City Not Provided Not Provided 30
10 Subscriber State Not Provided Not Provided 2
11 Subscriber Zipcode Not Provided Not Provided 15
12 Subscriber Phone Not Provided Not Provided 10
13 Subscriber Date of Birth Member date of birth. Not Provided CCYYMMDD 8
14 Subscriber Gender Member gender. Not Provided 1
15 Subscriber Secondary Identification Qualifier SECONDARY IDENTIFIERS IDCODE Definition Not Provided 2
16 Subscriber Secondary Identification Not Provided Not Provided 30
17 Patients Relationship to Insured Not Provided Not Provided 2
18 Patient Last name Patient / Member Information Not Provided 35
19 Patient First name Not Provided Not Provided 25
20 Patient Middle Name Not Provided Not Provided 25
21 Patient Primary Identifier Not Provided Not Provided 80
22 Patient Address Not Provided Not Provided 55
23 Patient Address 2 Not Provided Not Provided 55
24 Patient City Not Provided Not Provided 30
25 Patient State Not Provided Not Provided 2
26 Patient ZipCode Not Provided Not Provided 15
27 Patient Phone Not Provided Not Provided 10
28 Patient Date of Birth Member date of birth. Not Provided CCYYMMDD 8
29 Patient Gender Member gender. Not Provided 1
30 Patient Secondary Identification Qualifier SECONDARY IDENTIFIERS IDCODE Definition Not Provided 3
31 Patient Secondary Identification Not Provided Not Provided 30
32 RxClaimNo Unique prescription claim number. This generally is NOT the individual pharmacy prescription number, but rather the pharmacy benefit manager (PBM) transaction number. Not Provided 30
33 RxClaimNoCrossRef Refers to the RxClaimNo of related transaction. For adjustments, this field refers to the RxClaimNo of the claim that is being adjusted. Not Provided 30
34 RxNo Unique prescription number assigned by the pharmacy. Not Provided 10
35 PBMMebID The pharmacy benefit manager's member id. Not Provided 40
36 RXClaimTxnType The disposition type associated with this claim line. Not Provided 1
37 RxType The channel type used to fill the prescription. Not Provided 1
38 RxClaimXrefNo Rx Claim cross-reference number. If this is other than an original claim (i.e. reversal, adjustment, etc.), this field contains the RxClaimNo to which this adjustment transaction applies. Not Provided 30
39 RxAdjType Adjustment type code. Only valued for adjustment lines to an original RxClaimNo. Identifies the type of adjustment being performed. If valued, either RxClaimXrefNo or RxPairedAdjSeqNo must be valued. Not Provided 2
40 SubscriberSfx A suffix code applied to the the subscriber or certificate number. Not Provided 4
41 RxPrescriberID The prescription's Prescriber ID. This could be almost any number and may be dictated by the PBM. For example, this could be a NPI, DEA, UPIN, or a state ID (like MediCare). Not Provided 80
42 RxPrescriberNoType The type of RXPrescriberNo supplied on the record. Not Provided 1
43 RxPrescriberName Not Provided Not Provided 80
44 RxPharmacyNo Pharmacy ID of the pharmacy filling the prescription. This should be the pharmacy's unique NABP (National Association of Boards of Pharmacy) number. Alternately, this could be a unique PBM-assigned identifier. Not Provided 20
45 MembMcareSTatus Designates the Medicare status of the Rx claim. Not Provided 9 1
46 RxWrittenDt The date the original prescription was written. Not Provided CCYYMMDD 8
47 RxFilledDt The date the original prescription was filled Not Provided CCYYMMDD 8
48 Reject Code 1 Note: This field has 5 occurrences. Code indicating the error encountered. Code indicating the error encountered. Note that the values found in this field can vary based on pharmacy vs. member submitted claims (directs). Not Provided 3
49 Reject Code 2 Note: This field has 5 occurrences. Code indicating the error encountered. Code indicating the error encountered. Note that the values found in this field can vary based on pharmacy vs. member submitted claims (directs). Not Provided 3
50 Reject Code 3 Note: This field has 5 occurrences. Code indicating the error encountered. Code indicating the error encountered. Note that the values found in this field can vary based on pharmacy vs. member submitted claims (directs). Not Provided 3
51 Reject Code 4 Note: This field has 5 occurrences. Code indicating the error encountered. Code indicating the error encountered. Note that the values found in this field can vary based on pharmacy vs. member submitted claims (directs). Not Provided 3
52 Reject Code 5 Note: This field has 5 occurrences. Code indicating the error encountered. Code indicating the error encountered. Note that the values found in this field can vary based on pharmacy vs. member submitted claims (directs). Not Provided 3
53 RxPaidDt The date the prescription claim was paid. Not Provided CCYYMMDD 8
54 RxTotalPdAmt The amount paid by the plan for the prescription. Not Provided 9999999.99 10
55 PatientPaidAmount Not Provided Not Provided 10
56 RxQualifier Code qualifying the value found in the 'RxID' field. Not Provided 2
57 RxID ID of the product dispensed. The value contained in this field is defined by the 'RxQualifer Field'. Not Provided 19
58 RxNDC The full National Drug Code (NDC) of the drug used to fill the prescription. Dashes must be removed and the NDC formatted to a standard 11 character code. See the Additional Data feed Documentation for specific standard formats. See Additional Data Feed Documentation: National Drug Code Format: 99999999999 Not Provided 99999999999 11
59 RxTradeNm The trade (brand) name and strength of the drug used to fill the prescription. Not Provided 50
60 RxGenericNm The generic name and strength of the drug used to fill the prescription. Not Provided 50
61 GCNNumber Generic code of the drug as defined in First Data Bank's Blue Book. Not Provided 14
62 GPINumber GPI (Generic Product Identifier) Not Provided 14
63 UnitsOfMeasure Indicates the dosage form of the drug Note: Not available for compound drugs. Not Provided 2
64 UnitDoseIndicator A one position field indicating if the drug is packaged in unit dose. Not Provided 1
65 DispensingStatus Indicates if the prescription was a partial fill or the completion of a partial fill. This data is submitted by the pharmacy. Note that if a partial fill is submitted by a pharmacy, this field must be submitted with a 'p' or 'c' value. Not Provided 1
66 QuantityIntended Metric decimal quantity that would have been dispensed on original filling if inventory were available. This field is submitted by the pharmacy. Note that this field will only be populated if the claim is for a partial fill. Not Provided 10
67 RxMtrcFilQty The metric quantity of the drug used to fill the prescription. Not Provided 99999.99 15
68 RxDaysSupplyNo The days supply of medication for this (re)fill of the prescription. Not Provided 999 3
69 DrugStrength Drug Strength (e.g. 500MG, 0.5% etc.) Not Provided 10
70 DosageDescription Not Provided Not Provided 2
71 CompoundIndicator Indicates if the drug dispensed is a compound Not Provided 1
72 RxNoRefills The number of refills on the original prescription. Not Provided 99 2
73 RxRefillNo Code identifying whether the prescription is an original This field represents the Fill Number as submitted by the pharmacy. Not Provided 2
74 RxDAWCode The Dispense As Written (DAW) code associated with the prescription. Code indicating whether or not the prescriber's instructions regarding generic substitution were followed. Submitted by pharmacy. Note that this field is required to be submitted by pharmacies and therefore should always be populated. Not Provided 1
75 Therapeutic ClassCode - AHFS Identifies therapeutic category of drug according to the American Hospital Formulary Service classification system. Not Provided 8
76 USC Code USC Code (Universal System of Classification) Not Provided 5
77 DEA Class of Drug Indicates abuse potential for a controlled drug Not Provided 1
78 Drug Class Indicates drug availability to the consumer according to Federal specifications. Not Provided 1
79 Drug Category Code Indicates that a drug product belongs to a category that is commonly treated as an exception in Third Party Plans; categorized by therapeutic class. Not Provided 1
80 RxBrandInd Identifies whether an Rx was filled with the branded drug or with a generic. Not Provided 1
81 RecordDateTimeStamp The date on which the record was last updated on record's source system. Not Provided CCYYMMDDHHMM 12

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Data Element ID Data Element Code Value
14 Subscriber Gender F Female
M Male
15 Subscriber Secondary Identification Qualifier 1W Member Identification Number If NM108 = MI, this qualifier cannot be used.
23 Client Number
IG Insurance Policy Number
SY Social Security Number
17 Patients Relationship to Insured 01 Spouse
04 Grandfather or Grandmother
05 Grandson or Granddaughter
07 Nephew or Niece
09 Adopted Child
10 Foster Child
15 Ward
17 Stepson or Stepdaughter
18 Self
19 Child
20 Employee
21 Unknown
22 Handicapped Dependent
23 Sponsored Dependent
24 Dependent of a Minor Dependent
29 Significant Other
32 Mother
33 Father
34 Other Adult
36 Emancipated Minor
39 Organ Donor
40 Cadaver Donor
41 Injured Plaintiff
43 Child Where Insured Has No Financial Responsibility
53 Life Partner
G8 Other Relationship
29 Patient Gender F Female
M Male
30 Patient Secondary Identification Qualifier 1W Member Identification Number If NM108 = MI, this qualifier cannot be used.
23 Client Number
IG Insurance Policy Number
SY Social Security Number
36 RXClaimTxnType 0 Original Claim
1 Adjustment
3 Reversal
4 Replacement
5 Dummy Claim
37 RxType 0 Unknown
1 Retail
2 Mail Order
9 Other
39 RxAdjType 00 Original claim
01 Partial positive adjustment ($ or qty)
02 Partial negative adjustment ($ or qty)
03 Full reversal (delete)
42 RxPrescriberNoType 0 NPI
1 UPIN
2 DEA
3 TIN
4 State license no
8 PBM assigned
9 Other
45 MembMcareSTatus 0 Non-Medicare
1 Medicare primary
2 Medicare eligible
3 Unknown
48 Reject Code 1 *95 Time out
*96 Scheduled downtime
*97 Payer unavailable
*98 Connection to payer is down
1C Missing\invalid smoker/non smoker code
1E Missing\invalid prescriber location code
2C Missing\invalid pregnancy indicator
2E Missing\invalid primary care provider id qualifier
3A Missing\invalid request type
3B Missing\invalid request period date begin
3C Missing\invalid request period date end
3D Missing\invalid basis of request
3E Missing\invalid authorized representative first name
3F Missing\invalid authorized representative last name
3G Missing\invalid authorized representative street address
3H Missing\invalid authorized representative city address
3J Missing\invalid authorized representative state/province address
3K Missing\invalid authorized representative zip/postal zone
3M Missing\invalid prescriber phone number
3N Missing\invalid prior authorized number assigned
3P Missing\invalid authorization number
3R Prior authorization not required
3S Missing\invalid prior authorization supporting documentation
3T Active prior authorization exists resubmit at expiration of prior authorization
3W Prior authorization in process
3X Authorization number not found
3Y Prior authorization denied
4C Missing\invalid coordination of benefits/other payments count
4E Missing\invalid primary care provider last name
5C Missing\invalid other payer coverage type
5E Missing\invalid other payer reject count
6C Missing\invalid other payer id qualifier
6E Missing\invalid other payer reject code
7C Missing\invalid other payer id
7E Missing\invalid dur/pps code counter
8C Missing\invalid facility id
8E Missing\invalid dur/pps level of effort
00 No Reject Code Applies
01 Missing\invalid bin
02 Missing\invalid version number
03 Missing\invalid transaction code
04 Missing\invalid processor control number
05 Missing\invalid pharmacy number
06 Missing\invalid group number
07 Missing\invalid cardholder id number
08 Missing\invalid person code
09 Missing\invalid birth date
10 Missing\invalid patient gender code
11 Missing\invalid patient relationship code
12 Missing\invalid patient location
13 Missing\invalid other coverage cod
14 Missing\invalid eligibility clarification code
15 MISSING\INVALID Date of Service
16 Missing\invalid prescription/service reference number
17 Missing\invalid fill number
19 Missing\invalid days supply
20 Missing\invalid compound code
21 Missing\invalid product/service id
22 Missing\invalid dispense as written (daw)/product selection code
23 Missing\invalid ingredient cost submitted
25 Missing\invalid prescriber id
26 Missing\invalid unit of measure
28 Missing\invalid date prescription written
29 Missing\invalid number refills authorized
32 Missing\invalid level of service
33 Missing\invalid prescription origin code
34 Missing\invalid submission clarification code
35 Missing\invalid primary care provider id
38 Missing\invalid basis of cost
39 Missing\invalid diagnosis code
40 Pharmacy not contracted with plan on date of service
41 Submit bill to other processor or primary payer
50 Non matched pharmacy number
51 Non matched group id
52 Non matched cardholder id
53 Non matched person code
54 Non matched product/service id number
55 Non matched product package size
56 Non matched prescriber id
58 Non matched primary prescriber
60 Product/service not covered for patient age
61 Product/service not covered for patient gender
62 Patient/card holder id name mismatch
63 Institutionalized patient product/service id not covered
64 Claim submitted does not match prior authorization
65 Patient is not covered
66 Patient age exceeds maximum age
67 Filled before coverage effective
68 Filled after coverage expired
69 Filled after coverage terminated
70 Product/service not covered
71 Prescriber is not covered
72 Primary prescriber is not covered
73 Refills are not covered
74 Other carrier payment meets or exceeds payable
75 Prior authorization required
76 Plan limitations exceeded
77 Discontinued product/service id number
78 Cost exceeds maximum
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
85 Claim not processed
86 Submit manual reversal
87 Reversal not processed
88 Dur reject error
89 Rejected claim fees paid
90 Host hung up
91 Host response error
92 System unavailable/host unavailable
99 Host processing error
000 No Reject Code Applies
A9 Missing\invalid transaction count
AA Patient spenddown not met
AB Date written is after date filled
AC Product not covered non participating manufacturer
AD Billing provider not eligible to bill this claim type
AE Qmb (qualified medicare beneficiary) bill medicare
AF Patient enrolled under managed care
AG Days supply limitation for product/service
AH Unit dose packaging only payable for nursing home recipients
AJ Generic drug required
AK Missing\invalid software vendor/certification id
AM Missing\invalid segment identification
B2 Missing\invalid service provider id qualifier
BE Missing\invalid professional service fee submitted
CA Missing\invalid patient first name
CB Missing\invalid patient last name
CC Missing\invalid cardholder first name
CD Missing\invalid cardholder last name
CE Missing\invalid home plan
CF Missing\invalid employer name
CG Missing\invalid employer street address
CH Missing\invalid employer city address
CI Missing\invalid employer state/province address
CJ Missing\invalid employer zip postal zone
CK Missing\invalid employer phone number
CL Missing\invalid employer contact name
CM Missing\invalid patient street address
CN Missing\invalid patient city address
CO Missing\invalid patient state/province address
CP Missing\invalid patient zip/postal zone
CQ Missing\invalid patient phone number
CR Missing\invalid carrier id
CW Missing\invalid alternate id
CX Missing\invalid patient id qualifier
CY Missing\invalid patient id
CZ Missing\invalid employer id
DC Missing\invalid dispensing fee submitted
DN Missing\invalid basis of cost determination
DQ Missing\invalid usual and customary charge
DR Missing\invalid prescriber last name
DT Missing\invalid unit dose indicator
DU Missing\invalid gross amount due
DV Missing\invalid other payer amount paid
DX Missing\invalid patient paid amount submitted
DY Missing\invalid date of injury
DZ Missing\invalid claim/reference id
E1 Missing\invalid product/service id qualifier
E3 Missing\invalid incentive amount submitted
E4 Missing\invalid reason for service code
E5 Missing\invalid professional service code
E6 Missing\invalid result of service code
E7 Missing\invalid quantity dispensed
E8 Missing\invalid other payer date
E9 Missing\invalid provider id
EA Missing\invalid originally prescribed product/service code
EB Missing\invalid originally prescribed quantity
EC Missing\invalid compound ingredient component count
ED Missing\invalid compound ingredient quantity
EE Missing\invalid compound ingredient drug cost
EF Missing\invalid compound dosage form descriptin code
EG Missing\invalid compound dispensing unit form indicator
EH Missing\invalid compound route of administration
EJ Missing\invalid originally prescribed product/service id qualifier
EK Missing\invalid scheduled prescription id number
EM Missing\invalid prescription/service reference number qualifier
EN Missing\invalid associated prescription/service reference number
EP Missing\invalid associated prescription/service date
ER Missing\invalid procedure modifier code
ET Missing\invalid quantity prescribed
EU Missing\invalid prior authorization type code
EV Missing\invalid prior authorization number submitted
EW Missing\invalid intermediary authorization type id
EX Missing\invalid intermediary authorization id
EY Missing\invalid provider id qualifier
EZ Missing\invalid prescriber id qualifier
FO Missing\invalid plan id
GE Missing\invalid percentage sales tax amount submitted
H1 Missing\invalid measurement time
H2 Missing\invalid measurement dimension
H3 Missing\invalid measurement unit
H4 Missing\invalid measurement value
H5 Missing\invalid primary care provider location code
H6 Missing\invalid dur co agent id
H7 Missing\invalid other amount claimed submitted count
H8 Missing\invalid other amount claimed submitted qualifier
H9 Missing\invalid other amount claimed submitted
HA Missing\invalid flat sales tax amount submitted
HB Missing\invalid other payer amount paid count
HC Missing\invalid other payer amount paid qualifier
HD Missing\invalid dispensing status
HE Missing\invalid percentage sales tax rate submitted
HF Missing\invalid quantity intended to be dispensed
HG Missing\invalid days supply intended to be dispensed
J9 Missing\invalid dur co agent id qualifier
JE Missing\invalid percentage sales tax basis submitted
KE Missing\invalid coupon type
M1 Patient not covered in this aid category
M2 Recipient locked in
M3 Host pa/mc error
M4 Prescription/service reference number/time limit exceeded
M5 Requires manual claim
M6 Host eligibility error
M7 Host drug file error
M8 Host provider file error
ME Missing\invalid coupon number
MZ Error overflow
NE Missing\invalid coupon value amount
NN Transaction rejected at switch or intermediary
P1 Associated prescription/service reference number not found
P2 Clinical information counter out of sequence
P3 Compound ingredient component count does not match number of repetitions
P4 Coordination of benefits/other payments count does not match number of repetitions
P5 Coupon expired
P6 Date of service prior to date of birth
P7 Diagnosis code count does not match number of repetitions
P8 Dur/pps code counter out of sequence
P9 Field is non repeatable
PA Pa exhausted/not renewable
PB Invalid transaction count for this transaction code
PC Missing\invalid claim segment
PD Missing\invalid clinical segment
PE Missing\invalid cob/other payments segment
PF Missing\invalid compound segment
PG Missing\invalid coupon segment
PH Missing\invalid dur/pps segment
PJ Missing\invalid insurance segment
PK Missing\invalid patient segment
PM Missing\invalid pharmacy provider segment
PN Missing\invalid prescriber segment
PP Missing\invalid pricing segment
PR Missing\invalid prior authorization segment
PS Missing\invalid transaction header segment
PT Missing\invalid workers' compensation segment
PV Non matched associated prescription/service date
PW Non matched employer id
PX Non matched other payer id
PY Non Matched Unit Form/Route of Administration
PZ Non matched unit of measure to product/service id
R1 Other amount claimed submitted count does not match number of repetitions
R2 Other payer reject count does not match number of repetitions
R3 Procedure modifier code count does not match number of repetitions
R4 Procedure modifier code invalid for product/service id
R5 Product/service id must be zero when product/service id qualifier equals 06
R6 Product/service not appropriate for this location
R7 Repeating segment not allowed in same transaction
R8 Syntax error
R9 Value in gross amount due does not follow pricing formulae
RA Pa reversal out of order
RB Multiple partials not allowed
RC Different drug entity between partial & completion
RD Mismatched cardholder/group id partial to completion
RE Missing\invalid compound product id qualifier
RF Improper order of 'dispensing status' code on partial fill transaction
RG MISSING\INVALID Associated Prescription/service Reference Number On Completion Transaction
RH Missing\invalid associated prescription/service date on completion transaction
RJ Associated partial fill transaction not on file
RK Partial fill transaction not supported
RM Completion transaction not permitted with same 'date of service' as partial transaction
RN Plan limits exceeded on intended partial fill values
RP Out of sequence 'p' reversal on partial fill transaction
RS Missing\invalid associated prescription/service date on partial transaction
RT Missing\invalid associated prescription/service reference number on partial transaction
RU Mandatory data elements must occur before optional data elements in a segment
SE Missing\invalid procedure modifier code count
TE Missing\invalid compound product id
UE Missing\invalid compound ingredient basis of cost determination
VE Missing\invalid diagnosis code count
WE Missing\invalid diagnosis code qualifier
XE Missing\invalid clinical information counter
ZE Missing\invalid measurement date
49 Reject Code 2 *95 Time out
*96 Scheduled downtime
*97 Payer unavailable
*98 Connection to payer is down
1C Missing\invalid smoker/non smoker code
1E Missing\invalid prescriber location code
2C Missing\invalid pregnancy indicator
2E Missing\invalid primary care provider id qualifier
3A Missing\invalid request type
3B Missing\invalid request period date begin
3C Missing\invalid request period date end
3D Missing\invalid basis of request
3E Missing\invalid authorized representative first name
3F Missing\invalid authorized representative last name
3G Missing\invalid authorized representative street address
3H Missing\invalid authorized representative city address
3J Missing\invalid authorized representative state/province address
3K Missing\invalid authorized representative zip/postal zone
3M Missing\invalid prescriber phone number
3N Missing\invalid prior authorized number assigned
3P Missing\invalid authorization number
3R Prior authorization not required
3S Missing\invalid prior authorization supporting documentation
3T Active prior authorization exists resubmit at expiration of prior authorization
3W Prior authorization in process
3X Authorization number not found
3Y Prior authorization denied
4C Missing\invalid coordination of benefits/other payments count
4E Missing\invalid primary care provider last name
5C Missing\invalid other payer coverage type
5E Missing\invalid other payer reject count
6C Missing\invalid other payer id qualifier
6E Missing\invalid other payer reject code
7C Missing\invalid other payer id
7E Missing\invalid dur/pps code counter
8C Missing\invalid facility id
8E Missing\invalid dur/pps level of effort
00 No Reject Code Applies
01 Missing\invalid bin
02 Missing\invalid version number
03 Missing\invalid transaction code
04 Missing\invalid processor control number
05 Missing\invalid pharmacy number
06 Missing\invalid group number
07 Missing\invalid cardholder id number
08 Missing\invalid person code
09 Missing\invalid birth date
10 Missing\invalid patient gender code
11 Missing\invalid patient relationship code
12 Missing\invalid patient location
13 Missing\invalid other coverage cod
14 Missing\invalid eligibility clarification code
15 MISSING\INVALID Date of Service
16 Missing\invalid prescription/service reference number
17 Missing\invalid fill number
19 Missing\invalid days supply
20 Missing\invalid compound code
21 Missing\invalid product/service id
22 Missing\invalid dispense as written (daw)/product selection code
23 Missing\invalid ingredient cost submitted
25 Missing\invalid prescriber id
26 Missing\invalid unit of measure
28 Missing\invalid date prescription written
29 Missing\invalid number refills authorized
32 Missing\invalid level of service
33 Missing\invalid prescription origin code
34 Missing\invalid submission clarification code
35 Missing\invalid primary care provider id
38 Missing\invalid basis of cost
39 Missing\invalid diagnosis code
40 Pharmacy not contracted with plan on date of service
41 Submit bill to other processor or primary payer
50 Non matched pharmacy number
51 Non matched group id
52 Non matched cardholder id
53 Non matched person code
54 Non matched product/service id number
55 Non matched product package size
56 Non matched prescriber id
58 Non matched primary prescriber
60 Product/service not covered for patient age
61 Product/service not covered for patient gender
62 Patient/card holder id name mismatch
63 Institutionalized patient product/service id not covered
64 Claim submitted does not match prior authorization
65 Patient is not covered
66 Patient age exceeds maximum age
67 Filled before coverage effective
68 Filled after coverage expired
69 Filled after coverage terminated
70 Product/service not covered
71 Prescriber is not covered
72 Primary prescriber is not covered
73 Refills are not covered
74 Other carrier payment meets or exceeds payable
75 Prior authorization required
76 Plan limitations exceeded
77 Discontinued product/service id number
78 Cost exceeds maximum
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
85 Claim not processed
86 Submit manual reversal
87 Reversal not processed
88 Dur reject error
89 Rejected claim fees paid
90 Host hung up
91 Host response error
92 System unavailable/host unavailable
99 Host processing error
000 No Reject Code Applies
A9 Missing\invalid transaction count
AA Patient spenddown not met
AB Date written is after date filled
AC Product not covered non participating manufacturer
AD Billing provider not eligible to bill this claim type
AE Qmb (qualified medicare beneficiary) bill medicare
AF Patient enrolled under managed care
AG Days supply limitation for product/service
AH Unit dose packaging only payable for nursing home recipients
AJ Generic drug required
AK Missing\invalid software vendor/certification id
AM Missing\invalid segment identification
B2 Missing\invalid service provider id qualifier
BE Missing\invalid professional service fee submitted
CA Missing\invalid patient first name
CB Missing\invalid patient last name
CC Missing\invalid cardholder first name
CD Missing\invalid cardholder last name
CE Missing\invalid home plan
CF Missing\invalid employer name
CG Missing\invalid employer street address
CH Missing\invalid employer city address
CI Missing\invalid employer state/province address
CJ Missing\invalid employer zip postal zone
CK Missing\invalid employer phone number
CL Missing\invalid employer contact name
CM Missing\invalid patient street address
CN Missing\invalid patient city address
CO Missing\invalid patient state/province address
CP Missing\invalid patient zip/postal zone
CQ Missing\invalid patient phone number
CR Missing\invalid carrier id
CW Missing\invalid alternate id
CX Missing\invalid patient id qualifier
CY Missing\invalid patient id
CZ Missing\invalid employer id
DC Missing\invalid dispensing fee submitted
DN Missing\invalid basis of cost determination
DQ Missing\invalid usual and customary charge
DR Missing\invalid prescriber last name
DT Missing\invalid unit dose indicator
DU Missing\invalid gross amount due
DV Missing\invalid other payer amount paid
DX Missing\invalid patient paid amount submitted
DY Missing\invalid date of injury
DZ Missing\invalid claim/reference id
E1 Missing\invalid product/service id qualifier
E3 Missing\invalid incentive amount submitted
E4 Missing\invalid reason for service code
E5 Missing\invalid professional service code
E6 Missing\invalid result of service code
E7 Missing\invalid quantity dispensed
E8 Missing\invalid other payer date
E9 Missing\invalid provider id
EA Missing\invalid originally prescribed product/service code
EB Missing\invalid originally prescribed quantity
EC Missing\invalid compound ingredient component count
ED Missing\invalid compound ingredient quantity
EE Missing\invalid compound ingredient drug cost
EF Missing\invalid compound dosage form descriptin code
EG Missing\invalid compound dispensing unit form indicator
EH Missing\invalid compound route of administration
EJ Missing\invalid originally prescribed product/service id qualifier
EK Missing\invalid scheduled prescription id number
EM Missing\invalid prescription/service reference number qualifier
EN Missing\invalid associated prescription/service reference number
EP Missing\invalid associated prescription/service date
ER Missing\invalid procedure modifier code
ET Missing\invalid quantity prescribed
EU Missing\invalid prior authorization type code
EV Missing\invalid prior authorization number submitted
EW Missing\invalid intermediary authorization type id
EX Missing\invalid intermediary authorization id
EY Missing\invalid provider id qualifier
EZ Missing\invalid prescriber id qualifier
FO Missing\invalid plan id
GE Missing\invalid percentage sales tax amount submitted
H1 Missing\invalid measurement time
H2 Missing\invalid measurement dimension
H3 Missing\invalid measurement unit
H4 Missing\invalid measurement value
H5 Missing\invalid primary care provider location code
H6 Missing\invalid dur co agent id
H7 Missing\invalid other amount claimed submitted count
H8 Missing\invalid other amount claimed submitted qualifier
H9 Missing\invalid other amount claimed submitted
HA Missing\invalid flat sales tax amount submitted
HB Missing\invalid other payer amount paid count
HC Missing\invalid other payer amount paid qualifier
HD Missing\invalid dispensing status
HE Missing\invalid percentage sales tax rate submitted
HF Missing\invalid quantity intended to be dispensed
HG Missing\invalid days supply intended to be dispensed
J9 Missing\invalid dur co agent id qualifier
JE Missing\invalid percentage sales tax basis submitted
KE Missing\invalid coupon type
M1 Patient not covered in this aid category
M2 Recipient locked in
M3 Host pa/mc error
M4 Prescription/service reference number/time limit exceeded
M5 Requires manual claim
M6 Host eligibility error
M7 Host drug file error
M8 Host provider file error
ME Missing\invalid coupon number
MZ Error overflow
NE Missing\invalid coupon value amount
NN Transaction rejected at switch or intermediary
P1 Associated prescription/service reference number not found
P2 Clinical information counter out of sequence
P3 Compound ingredient component count does not match number of repetitions
P4 Coordination of benefits/other payments count does not match number of repetitions
P5 Coupon expired
P6 Date of service prior to date of birth
P7 Diagnosis code count does not match number of repetitions
P8 Dur/pps code counter out of sequence
P9 Field is non repeatable
PA Pa exhausted/not renewable
PB Invalid transaction count for this transaction code
PC Missing\invalid claim segment
PD Missing\invalid clinical segment
PE Missing\invalid cob/other payments segment
PF Missing\invalid compound segment
PG Missing\invalid coupon segment
PH Missing\invalid dur/pps segment
PJ Missing\invalid insurance segment
PK Missing\invalid patient segment
PM Missing\invalid pharmacy provider segment
PN Missing\invalid prescriber segment
PP Missing\invalid pricing segment
PR Missing\invalid prior authorization segment
PS Missing\invalid transaction header segment
PT Missing\invalid workers' compensation segment
PV Non matched associated prescription/service date
PW Non matched employer id
PX Non matched other payer id
PY Non Matched Unit Form/Route of Administration
PZ Non matched unit of measure to product/service id
R1 Other amount claimed submitted count does not match number of repetitions
R2 Other payer reject count does not match number of repetitions
R3 Procedure modifier code count does not match number of repetitions
R4 Procedure modifier code invalid for product/service id
R5 Product/service id must be zero when product/service id qualifier equals 06
R6 Product/service not appropriate for this location
R7 Repeating segment not allowed in same transaction
R8 Syntax error
R9 Value in gross amount due does not follow pricing formulae
RA Pa reversal out of order
RB Multiple partials not allowed
RC Different drug entity between partial & completion
RD Mismatched cardholder/group id partial to completion
RE Missing\invalid compound product id qualifier
RF Improper order of 'dispensing status' code on partial fill transaction
RG MISSING\INVALID Associated Prescription/service Reference Number On Completion Transaction
RH Missing\invalid associated prescription/service date on completion transaction
RJ Associated partial fill transaction not on file
RK Partial fill transaction not supported
RM Completion transaction not permitted with same 'date of service' as partial transaction
RN Plan limits exceeded on intended partial fill values
RP Out of sequence 'p' reversal on partial fill transaction
RS Missing\invalid associated prescription/service date on partial transaction
RT Missing\invalid associated prescription/service reference number on partial transaction
RU Mandatory data elements must occur before optional data elements in a segment
SE Missing\invalid procedure modifier code count
TE Missing\invalid compound product id
UE Missing\invalid compound ingredient basis of cost determination
VE Missing\invalid diagnosis code count
WE Missing\invalid diagnosis code qualifier
XE Missing\invalid clinical information counter
ZE Missing\invalid measurement date
50 Reject Code 3 *95 Time out
*96 Scheduled downtime
*97 Payer unavailable
*98 Connection to payer is down
1C Missing\invalid smoker/non smoker code
1E Missing\invalid prescriber location code
2C Missing\invalid pregnancy indicator
2E Missing\invalid primary care provider id qualifier
3A Missing\invalid request type
3B Missing\invalid request period date begin
3C Missing\invalid request period date end
3D Missing\invalid basis of request
3E Missing\invalid authorized representative first name
3F Missing\invalid authorized representative last name
3G Missing\invalid authorized representative street address
3H Missing\invalid authorized representative city address
3J Missing\invalid authorized representative state/province address
3K Missing\invalid authorized representative zip/postal zone
3M Missing\invalid prescriber phone number
3N Missing\invalid prior authorized number assigned
3P Missing\invalid authorization number
3R Prior authorization not required
3S Missing\invalid prior authorization supporting documentation
3T Active prior authorization exists resubmit at expiration of prior authorization
3W Prior authorization in process
3X Authorization number not found
3Y Prior authorization denied
4C Missing\invalid coordination of benefits/other payments count
4E Missing\invalid primary care provider last name
5C Missing\invalid other payer coverage type
5E Missing\invalid other payer reject count
6C Missing\invalid other payer id qualifier
6E Missing\invalid other payer reject code
7C Missing\invalid other payer id
7E Missing\invalid dur/pps code counter
8C Missing\invalid facility id
8E Missing\invalid dur/pps level of effort
00 No Reject Code Applies
01 Missing\invalid bin
02 Missing\invalid version number
03 Missing\invalid transaction code
04 Missing\invalid processor control number
05 Missing\invalid pharmacy number
06 Missing\invalid group number
07 Missing\invalid cardholder id number
08 Missing\invalid person code
09 Missing\invalid birth date
10 Missing\invalid patient gender code
11 Missing\invalid patient relationship code
12 Missing\invalid patient location
13 Missing\invalid other coverage cod
14 Missing\invalid eligibility clarification code
15 MISSING\INVALID Date of Service
16 Missing\invalid prescription/service reference number
17 Missing\invalid fill number
19 Missing\invalid days supply
20 Missing\invalid compound code
21 Missing\invalid product/service id
22 Missing\invalid dispense as written (daw)/product selection code
23 Missing\invalid ingredient cost submitted
25 Missing\invalid prescriber id
26 Missing\invalid unit of measure
28 Missing\invalid date prescription written
29 Missing\invalid number refills authorized
32 Missing\invalid level of service
33 Missing\invalid prescription origin code
34 Missing\invalid submission clarification code
35 Missing\invalid primary care provider id
38 Missing\invalid basis of cost
39 Missing\invalid diagnosis code
40 Pharmacy not contracted with plan on date of service
41 Submit bill to other processor or primary payer
50 Non matched pharmacy number
51 Non matched group id
52 Non matched cardholder id
53 Non matched person code
54 Non matched product/service id number
55 Non matched product package size
56 Non matched prescriber id
58 Non matched primary prescriber
60 Product/service not covered for patient age
61 Product/service not covered for patient gender
62 Patient/card holder id name mismatch
63 Institutionalized patient product/service id not covered
64 Claim submitted does not match prior authorization
65 Patient is not covered
66 Patient age exceeds maximum age
67 Filled before coverage effective
68 Filled after coverage expired
69 Filled after coverage terminated
70 Product/service not covered
71 Prescriber is not covered
72 Primary prescriber is not covered
73 Refills are not covered
74 Other carrier payment meets or exceeds payable
75 Prior authorization required
76 Plan limitations exceeded
77 Discontinued product/service id number
78 Cost exceeds maximum
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
85 Claim not processed
86 Submit manual reversal
87 Reversal not processed
88 Dur reject error
89 Rejected claim fees paid
90 Host hung up
91 Host response error
92 System unavailable/host unavailable
99 Host processing error
000 No Reject Code Applies
A9 Missing\invalid transaction count
AA Patient spenddown not met
AB Date written is after date filled
AC Product not covered non participating manufacturer
AD Billing provider not eligible to bill this claim type
AE Qmb (qualified medicare beneficiary) bill medicare
AF Patient enrolled under managed care
AG Days supply limitation for product/service
AH Unit dose packaging only payable for nursing home recipients
AJ Generic drug required
AK Missing\invalid software vendor/certification id
AM Missing\invalid segment identification
B2 Missing\invalid service provider id qualifier
BE Missing\invalid professional service fee submitted
CA Missing\invalid patient first name
CB Missing\invalid patient last name
CC Missing\invalid cardholder first name
CD Missing\invalid cardholder last name
CE Missing\invalid home plan
CF Missing\invalid employer name
CG Missing\invalid employer street address
CH Missing\invalid employer city address
CI Missing\invalid employer state/province address
CJ Missing\invalid employer zip postal zone
CK Missing\invalid employer phone number
CL Missing\invalid employer contact name
CM Missing\invalid patient street address
CN Missing\invalid patient city address
CO Missing\invalid patient state/province address
CP Missing\invalid patient zip/postal zone
CQ Missing\invalid patient phone number
CR Missing\invalid carrier id
CW Missing\invalid alternate id
CX Missing\invalid patient id qualifier
CY Missing\invalid patient id
CZ Missing\invalid employer id
DC Missing\invalid dispensing fee submitted
DN Missing\invalid basis of cost determination
DQ Missing\invalid usual and customary charge
DR Missing\invalid prescriber last name
DT Missing\invalid unit dose indicator
DU Missing\invalid gross amount due
DV Missing\invalid other payer amount paid
DX Missing\invalid patient paid amount submitted
DY Missing\invalid date of injury
DZ Missing\invalid claim/reference id
E1 Missing\invalid product/service id qualifier
E3 Missing\invalid incentive amount submitted
E4 Missing\invalid reason for service code
E5 Missing\invalid professional service code
E6 Missing\invalid result of service code
E7 Missing\invalid quantity dispensed
E8 Missing\invalid other payer date
E9 Missing\invalid provider id
EA Missing\invalid originally prescribed product/service code
EB Missing\invalid originally prescribed quantity
EC Missing\invalid compound ingredient component count
ED Missing\invalid compound ingredient quantity
EE Missing\invalid compound ingredient drug cost
EF Missing\invalid compound dosage form descriptin code
EG Missing\invalid compound dispensing unit form indicator
EH Missing\invalid compound route of administration
EJ Missing\invalid originally prescribed product/service id qualifier
EK Missing\invalid scheduled prescription id number
EM Missing\invalid prescription/service reference number qualifier
EN Missing\invalid associated prescription/service reference number
EP Missing\invalid associated prescription/service date
ER Missing\invalid procedure modifier code
ET Missing\invalid quantity prescribed
EU Missing\invalid prior authorization type code
EV Missing\invalid prior authorization number submitted
EW Missing\invalid intermediary authorization type id
EX Missing\invalid intermediary authorization id
EY Missing\invalid provider id qualifier
EZ Missing\invalid prescriber id qualifier
FO Missing\invalid plan id
GE Missing\invalid percentage sales tax amount submitted
H1 Missing\invalid measurement time
H2 Missing\invalid measurement dimension
H3 Missing\invalid measurement unit
H4 Missing\invalid measurement value
H5 Missing\invalid primary care provider location code
H6 Missing\invalid dur co agent id
H7 Missing\invalid other amount claimed submitted count
H8 Missing\invalid other amount claimed submitted qualifier
H9 Missing\invalid other amount claimed submitted
HA Missing\invalid flat sales tax amount submitted
HB Missing\invalid other payer amount paid count
HC Missing\invalid other payer amount paid qualifier
HD Missing\invalid dispensing status
HE Missing\invalid percentage sales tax rate submitted
HF Missing\invalid quantity intended to be dispensed
HG Missing\invalid days supply intended to be dispensed
J9 Missing\invalid dur co agent id qualifier
JE Missing\invalid percentage sales tax basis submitted
KE Missing\invalid coupon type
M1 Patient not covered in this aid category
M2 Recipient locked in
M3 Host pa/mc error
M4 Prescription/service reference number/time limit exceeded
M5 Requires manual claim
M6 Host eligibility error
M7 Host drug file error
M8 Host provider file error
ME Missing\invalid coupon number
MZ Error overflow
NE Missing\invalid coupon value amount
NN Transaction rejected at switch or intermediary
P1 Associated prescription/service reference number not found
P2 Clinical information counter out of sequence
P3 Compound ingredient component count does not match number of repetitions
P4 Coordination of benefits/other payments count does not match number of repetitions
P5 Coupon expired
P6 Date of service prior to date of birth
P7 Diagnosis code count does not match number of repetitions
P8 Dur/pps code counter out of sequence
P9 Field is non repeatable
PA Pa exhausted/not renewable
PB Invalid transaction count for this transaction code
PC Missing\invalid claim segment
PD Missing\invalid clinical segment
PE Missing\invalid cob/other payments segment
PF Missing\invalid compound segment
PG Missing\invalid coupon segment
PH Missing\invalid dur/pps segment
PJ Missing\invalid insurance segment
PK Missing\invalid patient segment
PM Missing\invalid pharmacy provider segment
PN Missing\invalid prescriber segment
PP Missing\invalid pricing segment
PR Missing\invalid prior authorization segment
PS Missing\invalid transaction header segment
PT Missing\invalid workers' compensation segment
PV Non matched associated prescription/service date
PW Non matched employer id
PX Non matched other payer id
PY Non Matched Unit Form/Route of Administration
PZ Non matched unit of measure to product/service id
R1 Other amount claimed submitted count does not match number of repetitions
R2 Other payer reject count does not match number of repetitions
R3 Procedure modifier code count does not match number of repetitions
R4 Procedure modifier code invalid for product/service id
R5 Product/service id must be zero when product/service id qualifier equals 06
R6 Product/service not appropriate for this location
R7 Repeating segment not allowed in same transaction
R8 Syntax error
R9 Value in gross amount due does not follow pricing formulae
RA Pa reversal out of order
RB Multiple partials not allowed
RC Different drug entity between partial & completion
RD Mismatched cardholder/group id partial to completion
RE Missing\invalid compound product id qualifier
RF Improper order of 'dispensing status' code on partial fill transaction
RG MISSING\INVALID Associated Prescription/service Reference Number On Completion Transaction
RH Missing\invalid associated prescription/service date on completion transaction
RJ Associated partial fill transaction not on file
RK Partial fill transaction not supported
RM Completion transaction not permitted with same 'date of service' as partial transaction
RN Plan limits exceeded on intended partial fill values
RP Out of sequence 'p' reversal on partial fill transaction
RS Missing\invalid associated prescription/service date on partial transaction
RT Missing\invalid associated prescription/service reference number on partial transaction
RU Mandatory data elements must occur before optional data elements in a segment
SE Missing\invalid procedure modifier code count
TE Missing\invalid compound product id
UE Missing\invalid compound ingredient basis of cost determination
VE Missing\invalid diagnosis code count
WE Missing\invalid diagnosis code qualifier
XE Missing\invalid clinical information counter
ZE Missing\invalid measurement date
51 Reject Code 4 *95 Time out
*96 Scheduled downtime
*97 Payer unavailable
*98 Connection to payer is down
1C Missing\invalid smoker/non smoker code
1E Missing\invalid prescriber location code
2C Missing\invalid pregnancy indicator
2E Missing\invalid primary care provider id qualifier
3A Missing\invalid request type
3B Missing\invalid request period date begin
3C Missing\invalid request period date end
3D Missing\invalid basis of request
3E Missing\invalid authorized representative first name
3F Missing\invalid authorized representative last name
3G Missing\invalid authorized representative street address
3H Missing\invalid authorized representative city address
3J Missing\invalid authorized representative state/province address
3K Missing\invalid authorized representative zip/postal zone
3M Missing\invalid prescriber phone number
3N Missing\invalid prior authorized number assigned
3P Missing\invalid authorization number
3R Prior authorization not required
3S Missing\invalid prior authorization supporting documentation
3T Active prior authorization exists resubmit at expiration of prior authorization
3W Prior authorization in process
3X Authorization number not found
3Y Prior authorization denied
4C Missing\invalid coordination of benefits/other payments count
4E Missing\invalid primary care provider last name
5C Missing\invalid other payer coverage type
5E Missing\invalid other payer reject count
6C Missing\invalid other payer id qualifier
6E Missing\invalid other payer reject code
7C Missing\invalid other payer id
7E Missing\invalid dur/pps code counter
8C Missing\invalid facility id
8E Missing\invalid dur/pps level of effort
00 No Reject Code Applies
01 Missing\invalid bin
02 Missing\invalid version number
03 Missing\invalid transaction code
04 Missing\invalid processor control number
05 Missing\invalid pharmacy number
06 Missing\invalid group number
07 Missing\invalid cardholder id number
08 Missing\invalid person code
09 Missing\invalid birth date
10 Missing\invalid patient gender code
11 Missing\invalid patient relationship code
12 Missing\invalid patient location
13 Missing\invalid other coverage cod
14 Missing\invalid eligibility clarification code
15 MISSING\INVALID Date of Service
16 Missing\invalid prescription/service reference number
17 Missing\invalid fill number
19 Missing\invalid days supply
20 Missing\invalid compound code
21 Missing\invalid product/service id
22 Missing\invalid dispense as written (daw)/product selection code
23 Missing\invalid ingredient cost submitted
25 Missing\invalid prescriber id
26 Missing\invalid unit of measure
28 Missing\invalid date prescription written
29 Missing\invalid number refills authorized
32 Missing\invalid level of service
33 Missing\invalid prescription origin code
34 Missing\invalid submission clarification code
35 Missing\invalid primary care provider id
38 Missing\invalid basis of cost
39 Missing\invalid diagnosis code
40 Pharmacy not contracted with plan on date of service
41 Submit bill to other processor or primary payer
50 Non matched pharmacy number
51 Non matched group id
52 Non matched cardholder id
53 Non matched person code
54 Non matched product/service id number
55 Non matched product package size
56 Non matched prescriber id
58 Non matched primary prescriber
60 Product/service not covered for patient age
61 Product/service not covered for patient gender
62 Patient/card holder id name mismatch
63 Institutionalized patient product/service id not covered
64 Claim submitted does not match prior authorization
65 Patient is not covered
66 Patient age exceeds maximum age
67 Filled before coverage effective
68 Filled after coverage expired
69 Filled after coverage terminated
70 Product/service not covered
71 Prescriber is not covered
72 Primary prescriber is not covered
73 Refills are not covered
74 Other carrier payment meets or exceeds payable
75 Prior authorization required
76 Plan limitations exceeded
77 Discontinued product/service id number
78 Cost exceeds maximum
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
85 Claim not processed
86 Submit manual reversal
87 Reversal not processed
88 Dur reject error
89 Rejected claim fees paid
90 Host hung up
91 Host response error
92 System unavailable/host unavailable
99 Host processing error
000 No Reject Code Applies
A9 Missing\invalid transaction count
AA Patient spenddown not met
AB Date written is after date filled
AC Product not covered non participating manufacturer
AD Billing provider not eligible to bill this claim type
AE Qmb (qualified medicare beneficiary) bill medicare
AF Patient enrolled under managed care
AG Days supply limitation for product/service
AH Unit dose packaging only payable for nursing home recipients
AJ Generic drug required
AK Missing\invalid software vendor/certification id
AM Missing\invalid segment identification
B2 Missing\invalid service provider id qualifier
BE Missing\invalid professional service fee submitted
CA Missing\invalid patient first name
CB Missing\invalid patient last name
CC Missing\invalid cardholder first name
CD Missing\invalid cardholder last name
CE Missing\invalid home plan
CF Missing\invalid employer name
CG Missing\invalid employer street address
CH Missing\invalid employer city address
CI Missing\invalid employer state/province address
CJ Missing\invalid employer zip postal zone
CK Missing\invalid employer phone number
CL Missing\invalid employer contact name
CM Missing\invalid patient street address
CN Missing\invalid patient city address
CO Missing\invalid patient state/province address
CP Missing\invalid patient zip/postal zone
CQ Missing\invalid patient phone number
CR Missing\invalid carrier id
CW Missing\invalid alternate id
CX Missing\invalid patient id qualifier
CY Missing\invalid patient id
CZ Missing\invalid employer id
DC Missing\invalid dispensing fee submitted
DN Missing\invalid basis of cost determination
DQ Missing\invalid usual and customary charge
DR Missing\invalid prescriber last name
DT Missing\invalid unit dose indicator
DU Missing\invalid gross amount due
DV Missing\invalid other payer amount paid
DX Missing\invalid patient paid amount submitted
DY Missing\invalid date of injury
DZ Missing\invalid claim/reference id
E1 Missing\invalid product/service id qualifier
E3 Missing\invalid incentive amount submitted
E4 Missing\invalid reason for service code
E5 Missing\invalid professional service code
E6 Missing\invalid result of service code
E7 Missing\invalid quantity dispensed
E8 Missing\invalid other payer date
E9 Missing\invalid provider id
EA Missing\invalid originally prescribed product/service code
EB Missing\invalid originally prescribed quantity
EC Missing\invalid compound ingredient component count
ED Missing\invalid compound ingredient quantity
EE Missing\invalid compound ingredient drug cost
EF Missing\invalid compound dosage form descriptin code
EG Missing\invalid compound dispensing unit form indicator
EH Missing\invalid compound route of administration
EJ Missing\invalid originally prescribed product/service id qualifier
EK Missing\invalid scheduled prescription id number
EM Missing\invalid prescription/service reference number qualifier
EN Missing\invalid associated prescription/service reference number
EP Missing\invalid associated prescription/service date
ER Missing\invalid procedure modifier code
ET Missing\invalid quantity prescribed
EU Missing\invalid prior authorization type code
EV Missing\invalid prior authorization number submitted
EW Missing\invalid intermediary authorization type id
EX Missing\invalid intermediary authorization id
EY Missing\invalid provider id qualifier
EZ Missing\invalid prescriber id qualifier
FO Missing\invalid plan id
GE Missing\invalid percentage sales tax amount submitted
H1 Missing\invalid measurement time
H2 Missing\invalid measurement dimension
H3 Missing\invalid measurement unit
H4 Missing\invalid measurement value
H5 Missing\invalid primary care provider location code
H6 Missing\invalid dur co agent id
H7 Missing\invalid other amount claimed submitted count
H8 Missing\invalid other amount claimed submitted qualifier
H9 Missing\invalid other amount claimed submitted
HA Missing\invalid flat sales tax amount submitted
HB Missing\invalid other payer amount paid count
HC Missing\invalid other payer amount paid qualifier
HD Missing\invalid dispensing status
HE Missing\invalid percentage sales tax rate submitted
HF Missing\invalid quantity intended to be dispensed
HG Missing\invalid days supply intended to be dispensed
J9 Missing\invalid dur co agent id qualifier
JE Missing\invalid percentage sales tax basis submitted
KE Missing\invalid coupon type
M1 Patient not covered in this aid category
M2 Recipient locked in
M3 Host pa/mc error
M4 Prescription/service reference number/time limit exceeded
M5 Requires manual claim
M6 Host eligibility error
M7 Host drug file error
M8 Host provider file error
ME Missing\invalid coupon number
MZ Error overflow
NE Missing\invalid coupon value amount
NN Transaction rejected at switch or intermediary
P1 Associated prescription/service reference number not found
P2 Clinical information counter out of sequence
P3 Compound ingredient component count does not match number of repetitions
P4 Coordination of benefits/other payments count does not match number of repetitions
P5 Coupon expired
P6 Date of service prior to date of birth
P7 Diagnosis code count does not match number of repetitions
P8 Dur/pps code counter out of sequence
P9 Field is non repeatable
PA Pa exhausted/not renewable
PB Invalid transaction count for this transaction code
PC Missing\invalid claim segment
PD Missing\invalid clinical segment
PE Missing\invalid cob/other payments segment
PF Missing\invalid compound segment
PG Missing\invalid coupon segment
PH Missing\invalid dur/pps segment
PJ Missing\invalid insurance segment
PK Missing\invalid patient segment
PM Missing\invalid pharmacy provider segment
PN Missing\invalid prescriber segment
PP Missing\invalid pricing segment
PR Missing\invalid prior authorization segment
PS Missing\invalid transaction header segment
PT Missing\invalid workers' compensation segment
PV Non matched associated prescription/service date
PW Non matched employer id
PX Non matched other payer id
PY Non Matched Unit Form/Route of Administration
PZ Non matched unit of measure to product/service id
R1 Other amount claimed submitted count does not match number of repetitions
R2 Other payer reject count does not match number of repetitions
R3 Procedure modifier code count does not match number of repetitions
R4 Procedure modifier code invalid for product/service id
R5 Product/service id must be zero when product/service id qualifier equals 06
R6 Product/service not appropriate for this location
R7 Repeating segment not allowed in same transaction
R8 Syntax error
R9 Value in gross amount due does not follow pricing formulae
RA Pa reversal out of order
RB Multiple partials not allowed
RC Different drug entity between partial & completion
RD Mismatched cardholder/group id partial to completion
RE Missing\invalid compound product id qualifier
RF Improper order of 'dispensing status' code on partial fill transaction
RG MISSING\INVALID Associated Prescription/service Reference Number On Completion Transaction
RH Missing\invalid associated prescription/service date on completion transaction
RJ Associated partial fill transaction not on file
RK Partial fill transaction not supported
RM Completion transaction not permitted with same 'date of service' as partial transaction
RN Plan limits exceeded on intended partial fill values
RP Out of sequence 'p' reversal on partial fill transaction
RS Missing\invalid associated prescription/service date on partial transaction
RT Missing\invalid associated prescription/service reference number on partial transaction
RU Mandatory data elements must occur before optional data elements in a segment
SE Missing\invalid procedure modifier code count
TE Missing\invalid compound product id
UE Missing\invalid compound ingredient basis of cost determination
VE Missing\invalid diagnosis code count
WE Missing\invalid diagnosis code qualifier
XE Missing\invalid clinical information counter
ZE Missing\invalid measurement date
52 Reject Code 5 *95 Time out
*96 Scheduled downtime
*97 Payer unavailable
*98 Connection to payer is down
1C Missing\invalid smoker/non smoker code
1E Missing\invalid prescriber location code
2C Missing\invalid pregnancy indicator
2E Missing\invalid primary care provider id qualifier
3A Missing\invalid request type
3B Missing\invalid request period date begin
3C Missing\invalid request period date end
3D Missing\invalid basis of request
3E Missing\invalid authorized representative first name
3F Missing\invalid authorized representative last name
3G Missing\invalid authorized representative street address
3H Missing\invalid authorized representative city address
3J Missing\invalid authorized representative state/province address
3K Missing\invalid authorized representative zip/postal zone
3M Missing\invalid prescriber phone number
3N Missing\invalid prior authorized number assigned
3P Missing\invalid authorization number
3R Prior authorization not required
3S Missing\invalid prior authorization supporting documentation
3T Active prior authorization exists resubmit at expiration of prior authorization
3W Prior authorization in process
3X Authorization number not found
3Y Prior authorization denied
4C Missing\invalid coordination of benefits/other payments count
4E Missing\invalid primary care provider last name
5C Missing\invalid other payer coverage type
5E Missing\invalid other payer reject count
6C Missing\invalid other payer id qualifier
6E Missing\invalid other payer reject code
7C Missing\invalid other payer id
7E Missing\invalid dur/pps code counter
8C Missing\invalid facility id
8E Missing\invalid dur/pps level of effort
00 No Reject Code Applies
01 Missing\invalid bin
02 Missing\invalid version number
03 Missing\invalid transaction code
04 Missing\invalid processor control number
05 Missing\invalid pharmacy number
06 Missing\invalid group number
07 Missing\invalid cardholder id number
08 Missing\invalid person code
09 Missing\invalid birth date
10 Missing\invalid patient gender code
11 Missing\invalid patient relationship code
12 Missing\invalid patient location
13 Missing\invalid other coverage cod
14 Missing\invalid eligibility clarification code
15 MISSING\INVALID Date of Service
16 Missing\invalid prescription/service reference number
17 Missing\invalid fill number
19 Missing\invalid days supply
20 Missing\invalid compound code
21 Missing\invalid product/service id
22 Missing\invalid dispense as written (daw)/product selection code
23 Missing\invalid ingredient cost submitted
25 Missing\invalid prescriber id
26 Missing\invalid unit of measure
28 Missing\invalid date prescription written
29 Missing\invalid number refills authorized
32 Missing\invalid level of service
33 Missing\invalid prescription origin code
34 Missing\invalid submission clarification code
35 Missing\invalid primary care provider id
38 Missing\invalid basis of cost
39 Missing\invalid diagnosis code
40 Pharmacy not contracted with plan on date of service
41 Submit bill to other processor or primary payer
50 Non matched pharmacy number
51 Non matched group id
52 Non matched cardholder id
53 Non matched person code
54 Non matched product/service id number
55 Non matched product package size
56 Non matched prescriber id
58 Non matched primary prescriber
60 Product/service not covered for patient age
61 Product/service not covered for patient gender
62 Patient/card holder id name mismatch
63 Institutionalized patient product/service id not covered
64 Claim submitted does not match prior authorization
65 Patient is not covered
66 Patient age exceeds maximum age
67 Filled before coverage effective
68 Filled after coverage expired
69 Filled after coverage terminated
70 Product/service not covered
71 Prescriber is not covered
72 Primary prescriber is not covered
73 Refills are not covered
74 Other carrier payment meets or exceeds payable
75 Prior authorization required
76 Plan limitations exceeded
77 Discontinued product/service id number
78 Cost exceeds maximum
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
85 Claim not processed
86 Submit manual reversal
87 Reversal not processed
88 Dur reject error
89 Rejected claim fees paid
90 Host hung up
91 Host response error
92 System unavailable/host unavailable
99 Host processing error
000 No Reject Code Applies
A9 Missing\invalid transaction count
AA Patient spenddown not met
AB Date written is after date filled
AC Product not covered non participating manufacturer
AD Billing provider not eligible to bill this claim type
AE Qmb (qualified medicare beneficiary) bill medicare
AF Patient enrolled under managed care
AG Days supply limitation for product/service
AH Unit dose packaging only payable for nursing home recipients
AJ Generic drug required
AK Missing\invalid software vendor/certification id
AM Missing\invalid segment identification
B2 Missing\invalid service provider id qualifier
BE Missing\invalid professional service fee submitted
CA Missing\invalid patient first name
CB Missing\invalid patient last name
CC Missing\invalid cardholder first name
CD Missing\invalid cardholder last name
CE Missing\invalid home plan
CF Missing\invalid employer name
CG Missing\invalid employer street address
CH Missing\invalid employer city address
CI Missing\invalid employer state/province address
CJ Missing\invalid employer zip postal zone
CK Missing\invalid employer phone number
CL Missing\invalid employer contact name
CM Missing\invalid patient street address
CN Missing\invalid patient city address
CO Missing\invalid patient state/province address
CP Missing\invalid patient zip/postal zone
CQ Missing\invalid patient phone number
CR Missing\invalid carrier id
CW Missing\invalid alternate id
CX Missing\invalid patient id qualifier
CY Missing\invalid patient id
CZ Missing\invalid employer id
DC Missing\invalid dispensing fee submitted
DN Missing\invalid basis of cost determination
DQ Missing\invalid usual and customary charge
DR Missing\invalid prescriber last name
DT Missing\invalid unit dose indicator
DU Missing\invalid gross amount due
DV Missing\invalid other payer amount paid
DX Missing\invalid patient paid amount submitted
DY Missing\invalid date of injury
DZ Missing\invalid claim/reference id
E1 Missing\invalid product/service id qualifier
E3 Missing\invalid incentive amount submitted
E4 Missing\invalid reason for service code
E5 Missing\invalid professional service code
E6 Missing\invalid result of service code
E7 Missing\invalid quantity dispensed
E8 Missing\invalid other payer date
E9 Missing\invalid provider id
EA Missing\invalid originally prescribed product/service code
EB Missing\invalid originally prescribed quantity
EC Missing\invalid compound ingredient component count
ED Missing\invalid compound ingredient quantity
EE Missing\invalid compound ingredient drug cost
EF Missing\invalid compound dosage form descriptin code
EG Missing\invalid compound dispensing unit form indicator
EH Missing\invalid compound route of administration
EJ Missing\invalid originally prescribed product/service id qualifier
EK Missing\invalid scheduled prescription id number
EM Missing\invalid prescription/service reference number qualifier
EN Missing\invalid associated prescription/service reference number
EP Missing\invalid associated prescription/service date
ER Missing\invalid procedure modifier code
ET Missing\invalid quantity prescribed
EU Missing\invalid prior authorization type code
EV Missing\invalid prior authorization number submitted
EW Missing\invalid intermediary authorization type id
EX Missing\invalid intermediary authorization id
EY Missing\invalid provider id qualifier
EZ Missing\invalid prescriber id qualifier
FO Missing\invalid plan id
GE Missing\invalid percentage sales tax amount submitted
H1 Missing\invalid measurement time
H2 Missing\invalid measurement dimension
H3 Missing\invalid measurement unit
H4 Missing\invalid measurement value
H5 Missing\invalid primary care provider location code
H6 Missing\invalid dur co agent id
H7 Missing\invalid other amount claimed submitted count
H8 Missing\invalid other amount claimed submitted qualifier
H9 Missing\invalid other amount claimed submitted
HA Missing\invalid flat sales tax amount submitted
HB Missing\invalid other payer amount paid count
HC Missing\invalid other payer amount paid qualifier
HD Missing\invalid dispensing status
HE Missing\invalid percentage sales tax rate submitted
HF Missing\invalid quantity intended to be dispensed
HG Missing\invalid days supply intended to be dispensed
J9 Missing\invalid dur co agent id qualifier
JE Missing\invalid percentage sales tax basis submitted
KE Missing\invalid coupon type
M1 Patient not covered in this aid category
M2 Recipient locked in
M3 Host pa/mc error
M4 Prescription/service reference number/time limit exceeded
M5 Requires manual claim
M6 Host eligibility error
M7 Host drug file error
M8 Host provider file error
ME Missing\invalid coupon number
MZ Error overflow
NE Missing\invalid coupon value amount
NN Transaction rejected at switch or intermediary
P1 Associated prescription/service reference number not found
P2 Clinical information counter out of sequence
P3 Compound ingredient component count does not match number of repetitions
P4 Coordination of benefits/other payments count does not match number of repetitions
P5 Coupon expired
P6 Date of service prior to date of birth
P7 Diagnosis code count does not match number of repetitions
P8 Dur/pps code counter out of sequence
P9 Field is non repeatable
PA Pa exhausted/not renewable
PB Invalid transaction count for this transaction code
PC Missing\invalid claim segment
PD Missing\invalid clinical segment
PE Missing\invalid cob/other payments segment
PF Missing\invalid compound segment
PG Missing\invalid coupon segment
PH Missing\invalid dur/pps segment
PJ Missing\invalid insurance segment
PK Missing\invalid patient segment
PM Missing\invalid pharmacy provider segment
PN Missing\invalid prescriber segment
PP Missing\invalid pricing segment
PR Missing\invalid prior authorization segment
PS Missing\invalid transaction header segment
PT Missing\invalid workers' compensation segment
PV Non matched associated prescription/service date
PW Non matched employer id
PX Non matched other payer id
PY Non Matched Unit Form/Route of Administration
PZ Non matched unit of measure to product/service id
R1 Other amount claimed submitted count does not match number of repetitions
R2 Other payer reject count does not match number of repetitions
R3 Procedure modifier code count does not match number of repetitions
R4 Procedure modifier code invalid for product/service id
R5 Product/service id must be zero when product/service id qualifier equals 06
R6 Product/service not appropriate for this location
R7 Repeating segment not allowed in same transaction
R8 Syntax error
R9 Value in gross amount due does not follow pricing formulae
RA Pa reversal out of order
RB Multiple partials not allowed
RC Different drug entity between partial & completion
RD Mismatched cardholder/group id partial to completion
RE Missing\invalid compound product id qualifier
RF Improper order of 'dispensing status' code on partial fill transaction
RG MISSING\INVALID Associated Prescription/service Reference Number On Completion Transaction
RH Missing\invalid associated prescription/service date on completion transaction
RJ Associated partial fill transaction not on file
RK Partial fill transaction not supported
RM Completion transaction not permitted with same 'date of service' as partial transaction
RN Plan limits exceeded on intended partial fill values
RP Out of sequence 'p' reversal on partial fill transaction
RS Missing\invalid associated prescription/service date on partial transaction
RT Missing\invalid associated prescription/service reference number on partial transaction
RU Mandatory data elements must occur before optional data elements in a segment
SE Missing\invalid procedure modifier code count
TE Missing\invalid compound product id
UE Missing\invalid compound ingredient basis of cost determination
VE Missing\invalid diagnosis code count
WE Missing\invalid diagnosis code qualifier
XE Missing\invalid clinical information counter
ZE Missing\invalid measurement date
56 RxQualifier 01 UPC (Universal Product Codes)
02 HRI Code (Health Related Item)
03 NDC (National Drug Code)
Space Not Specified
63 UnitsOfMeasure EA Each
GM Grams
ML Milliliters
space Not specified
64 UnitDoseIndicator N indicates drug is not unit dose.
Space Not Specified
Y indicates drug is Unit Dose
65 DispensingStatus C completion of partial fill
P partial fill
blank not a partial fill
70 DosageDescription AA aerosol (ml)
AB aerosol (gm)
AC aerosol (ea)
AD aerosol refill (ml)
AE aerosol refill (ea)
AF foam (gm)
AG aerosol refill (gm)
AH aerosol w/adapter (ml)
AJ aerosol w/adapter (gm)
AK aerosol, powder (ea)
AL ampul for nebulization (ml)
AM aerosol, mist
AN vial, nebulizer
AO aerosol, breath activated
AP aerosol, powder (gm)
AQ aerosol, spray, (gm)
AR spray, non-aerosol refill (ml)
AS aerosol, spray (ml)
AT aerosol, spray w/pump (ml)
AU spray, non-aerosol (ml)
AV foam (ml)
AW aerosol, foam with applicator (gm)
AX spray, non-aerosol (ea)
AY aerosol powder, breath activated
AZ aerosol, powder (ml)
BA bath (ea)
BB bath (ml)
BC bath (gm)
BD spray, non-aerosol (gm)
CA capsule (hard, soft, etc.)
CB capsule, sustained release 12 hr
CC capsule, sustained release 24 hr
CD capsule, with inhalation device
CE capsule, delayed release (enteric coated
CF capsule, delayed release (obs 06-25-01)
CK capsule, sprinkle
CM capsule, multiphasic release
CO capsule, 12hr sustained release pellets
CP capsule, 24hr sustained release pellets
CQ cap seq
CS capsule, sustained action
CT capsule, degradable controlled-release
DP dropperette, single-use drop dispenser
DS suspension,delayed release,reconst.
EA each
EB bar
EC cake
ED soap, medicated (ea)
EE soap, liquid
EF dental cone
EG stick (gm)
EH stick (ea)
EI cement (gm)
EJ plaster
EK poultice
EL swab, medicated
EM cone, medicated
EN tape, medicated
EP soap, medicated (ml)
ER soap, medicated (gm)
ET pads, medicated (ea)
FA flask for liquids
FB flask for solids
FI film, medicated (ea)
FS sheet (ea)
GA gas
GH inhaler (ml)
GI inhaler (ea)
GJ inhaler (gm)
GK disk, with inhalation device
HA infusion bottle (ea)
HB infusion bottle (ml)
HC pipette (ea)
HD pipette (ml)
HE allergen
HG ampul with device (ml)
HH ampul (ml)
HI cartridge (ea)
HJ cartridge (ml)
HK iv solution, piggyback premix frozen(ml)
HL bulk bag, injection (gm)
HM intravenous solution
HN intravenous solution, piggyback (ea)
HP intravenous solution, piggyback (ml)
HQ disposable syringe (ml)
HR ampul (ea)
HS vial (sdv,mdv or additive) (ea)
HT skin test
HU plastic bag, injection (ea)
HV vial (sdv,mdv or additive) (ml)
HW additive syringe (ml)
HX disposable syringe (ea)
HY intraperitoneal solution(ml)
HZ plastic bag, injection (ml)
IA implant (ea)
JA jelly (gm)
JB jel (ml)
JC gel (ml)
JD jel (gm)
JE beads (gm)
JF gel (ea)
JG gel (gm)
JH pudding (ea)
JI globule
JJ pudding (gm)
JP gel in packet (gm)
JS gel-forming solution
JT jelly with prefilled applicator (ml)
JU gel with prefilled applicator (gm)
JV gel with applicator (gm)
JW jelly with applicator (gm)
JX gel with applicator (ml)
JY solution with applicator (ea)
KA cream (grams)
KB cream, sustained release (gm)
KC suspension, topical (gm)
KD gel, sustained release (ml)
KL lubricant
KM cream (milliliters)
KP paste
KT toothpaste
KV cream with prefilled applicator
KW cream with applicator
OA ointment(gm)
OB ointment(ml)
OC ointment(ea)
OV ointment with prefilled applicator
OW ointment with applicator
PA powder (gm)
PB leaves (gm)
PC crystals
PD suspension, reconstituted, oral (ml)
PE powder effervescent (gm)
PF flakes (gm)
PG granules;powder-like,non-efervescent(gm)
PH drops, reconstituted, oral
PI solution, reconstituted, oral
PJ suspension, 12 hr sustained release
PK patch, transdermal weekly
PL cleanser (gm)
PM lump (gm)
PN cleanser (ml)
PO effpowdpkt
PP packet
PQ patch, transdermal biweekly
PR patch, transdermal 72 hours
PS adhesive patch, medicated
PU powder (units)
PV patch, transdermal 24 hours
PW tea (ea)
PX tea (gm)
PY suspension, 24 hr sustained release
PZ suspension in packet (ea)
QA suppository, rectal
QB insert
QC suppository, vaginal
QD suppository, urethral
QF suspension, reconstituted, oral (gm)
QV ring, vaginal
RA solution (gm)
RB emulsion (gm)
RC shampoo (gm)
RE shampoo cream (gm)
RF syrup (gm)
RG suspension, microcapsule reconstituted
RL liquid (gm)
SA solution, non-oral
SB fluid extract
SC suspension, oral (final dose form)
SE elixir
SF enema (ml)
SG enema (ea)
SH expectorant
SI liniment
SJ solution, oral
SK lotion (ml)
SL liquid (ml)
SM mouthwash
SN suspension, drops(final dosage form)(ml)
SO drops
SP spirit
SQ oil
SR suspension, topical (ml)
SS shampoo
ST syrup
SU emulsion
SV granules, effervescent
SW solution, irrigation
SX tincture
SY concentrate, oral
SZ lotion (gm)
TA tablet
TB tablet, soluble
TC tablet, chewable
TD disk
TE tablet dr
TF tablet, effervescent
TG gum
TH tablet, hypodermic
TI tablet, sustained release 24hr
TJ tablet, dispersible
TK gum(gm)
TL lozenge
TM tablet, sustained release 12hr
TN tablet, granule-like or packets
TO tablet, sustained release 12hr sequentia
TP pellet
TQ tablet, sust.release,particles/crystals
TR tablet, particles/crystals in
TS tablet, sustained action
TT troche
TU tablet, sublingual
TV tablet, buccal
TW wafer
TX pill
TY tablet, buccal sustained action
TZ tablet, osmotic laser-drilled form.
UA tablet seq
UB tablet, multiphasic release
UD tablet, dose pack
UE tablet, sustained action sequential
UL tablet, dispersible lingual
UN unit
WA wax (gm)
WB tar (gm)
YA needle, reusable
YB bulk
YC syringe, reusable
YD diaphragm
YE bandage
YF lens
YH needle, disposable
YI intrauterine device
YJ syringe, cornwall
YK kit
YL syringe, empty disposable
YM pad
YN tampon
YO towelette (ea)
YP intraperitoneal admin.sets-paraphernalia
YQ infusion sets-paraphernalia
YR strip
YT tape, non-medicated
YU irrigation set
YV sponge
YW swab, non-medicated
YX intravenous admixture accessories
YY kit,refill
YZ blood administration set
71 CompoundIndicator 0 unknown
1 Not a Compound
2 Compound
73 RxRefillNo 00 New
01-99 Refill number
74 RxDAWCode 0 Not DAW
1 Physician DAW
2 Patient DAW
3 Pharmacy DAW
4 Generic Not Available
5 Brand dispensed as generic
6 Other
7 Brand drug mandated by Law
8 Generic drug not available in market
9 Other
77 DEA Class of Drug 0 Not a controlled drug
1 Used for research only
2 Most potential for abuse
3 Less potential for abuse than 2
4 Less potential for abuse than 2 & 3
5 Least potential for abuse
78 Drug Class F Federal/Legend (Prescription Only)
I Insulin
O Over the counter
S State Restricted
79 Drug Category Code 0 Unspecified
1 Impotency Treatment
2 Growth hormone, GHRH, and related agents
A Anti-Anxiety Agents
B Fertility Agents
C Contraceptives, Oral
D Diagnostics
E Floride Preparations (excluding Vitalnin Combinations)
F Antiobestiy Drugs/Amphetamines
G Antacids
H Hematinics
I Insulins
J Smoking Deterrents
K AIDS related drugs
L Laxatives
M Reusable Needles (all)
N Disposable Needles (all)
O Reusable Syringes w/wo Needles (Non-Insulin)
P Disposable Syringes w/wo Needles (Non-Insulin)
Q Reusable Syringes w/wo Needles (Insulin)
R Disposable Syringes w/wo Needles (Insulin)
S Diabetic Supplies, Miscellaneous
T Contraceptives, Topical
U Products used for approved or unapproved cosmetic indications
V Vitamins, Commonly excluded
W Contraceptives, Implantable
Y Ostomy Supplies
Z Attention Deficit Disorder and Narcolepsy
80 RxBrandInd 0 Rx filled with a generic
1 Rx filled with the brand drug
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