{"aaData": [["01", "
M/I IIN Number
\n"], ["10", "
M/I Patient Gender Code
\n"], ["CA", "
M/I Patient First Name
\n"], ["ZB", "
M/I Seller ID Qualifier
\n"], ["ZC", "
Assoc Rx/Service Prov ID Qual Value Not Supported For Processor/Payer
\n"], ["ZD", "
Associated Rx/Service Reference Number Qualifier Value Not Supported
\n"], ["ZF", "
M/I Sales Transaction ID
\n"], ["ZK", "
M/I Prescriber ID Associated State/Province Address
\n"], ["ZM", "
M/I Prescriber Alternate ID Qualifier
\n"], ["ZN", "
Purchaser ID Qualifier Value Not Supported For Processor/Payer
\n"], ["ZP", "
M/I Prescriber Alternate ID
\n"], ["ZQ", "
M/I Prescriber Alternate ID Associated State/Province Address
\n"], ["ZS", "
M/I Reported Adjudicated Program Type
\n"], ["CB", "
M/I Patient Last Name
\n"], ["ZT", "
M/I Released Date
\n"], ["ZU", "
M/I Released Time
\n"], ["ZV", "
Reported Payment Type Value Not Supported
\n"], ["ZW", "
M/I Compound Preparation Time
\n"], ["ZX", "
M/I CMS Part D Contract ID
\n"], ["ZY", "
M/I Medicare Part D Plan Benefit Package (PBP)
\n"], ["ZZ", "
Cardholder ID submitted is inactive. New Cardholder ID on file
\n"], ["eC", "
CHAMPVA-NON BILLABLE
\n"], ["569", "
Provide Notice: Medicare Prescription Drug Coverage and Your Rights
\n"], ["597", "
LTC Dispensing Type Does Not Support The Packaging Type
\n"], ["CC", "
M/I Cardholder First Name
\n"], ["709", "
M/I Record Type
\n"], ["558", "
Part D Plan cannot coordinate benefits with another Part D Plan
\n"], ["559", "
ID Excluded Is Associated With A Sanctioned Pharmacy
\n"], ["560", "
Pharmacy Not Contracted in Retail Network
\n"], ["561", "
Pharmacy Not Contracted in Mail Order Network
\n"], ["562", "
Pharmacy Not Contracted in Hospice Network
\n"], ["563", "
Pharmacy Not Contracted in Veterans Administration Network
\n"], ["564", "
Pharmacy Not Contracted in Military Network
\n"], ["565", "
Patient Country Code Value Not Supported
\n"], ["566", "
Patient Country Code Not Used For This Transaction
\n"], ["CD", "
M/I Cardholder Last Name
\n"], ["567", "
M/I Veterinary Use Indicator
\n"], ["568", "
Veterinary Use Indicator Value Not Supported
\n"], ["570", "
Veterinary Use Indicator Not Used For This Transaction
\n"], ["571", "
Patient ID Associated State/Province Address Value Not Supported
\n"], ["572", "
Medigap ID Not Covered
\n"], ["573", "
Prescriber Alt ID Assoc State/Province Address Value Not Supported
\n"], ["574", "
Compound Ingredient Modifier Code Not Covered
\n"], ["575", "
Purchaser State/Province Address Value Not Supported
\n"], ["576", "
Service Provider State/Province Address Value Not Supported
\n"], ["577", "
M/I Other Payer ID
\n"], ["CE", "
M/I Home Plan
\n"], ["578", "
Other Payer ID Count Does Not Match Number of Repetitions
\n"], ["579", "
Other Payer ID Count Exceeds Number Of Occurrences Supported
\n"], ["580", "
Other Payer ID Count Grouping Incorrect
\n"], ["581", "
Other Payer ID Count is not used for this Transaction Code
\n"], ["582", "
M/I Fill Number
\n"], ["583", "
Provider ID Not Covered
\n"], ["584", "
Purchaser ID Associated State/Province Code Value Not Supported
\n"], ["585", "
Fill Number Value Not Supported
\n"], ["586", "
Facility ID Not Covered
\n"], ["587", "
Carrier ID Not Covered
\n"], ["CF", "
M/I Employer Name
\n"], ["588", "
Alternate ID Not Covered
\n"], ["589", "
Patient ID Not Covered
\n"], ["590", "
Compound Dosage Form Not Covered
\n"], ["591", "
Plan ID Not Covered
\n"], ["592", "
DUR Co-Agent ID Not Covered
\n"], ["593", "
M/I Date of Service
\n"], ["594", "
Pay To ID Not Covered
\n"], ["595", "
Associated Prescription/Service Provider ID Not Covered
\n"], ["596", "
Compound Preparation Time Not Used For This Transaction Code
\n"], ["598", "
More Than One Patient Found
\n"], ["CG", "
M/I Employer Street Address
\n"], ["599", "
Cardholder ID Matched But Last Name Did Not
\n"], ["600", "
Coverage Outside Submitted Date Of Service
\n"], ["601", "
Intermediary Auth Type ID Does Not Precede Intermediary Auth ID
\n"], ["602", "
Assoc Rx/Serv Prov ID Qual Does Not Precede Assoc Rx/Service Prov ID
\n"], ["603", "
Prescriber Alternate ID Qual Does Not Precede Prescriber Alternate ID
\n"], ["604", "
Purchaser ID Qualifier Does Not Precede Purchaser ID
\n"], ["605", "
Seller ID Qualifier Does Not Precede Seller ID
\n"], ["606", "
Brand Drug/Specific Labeler Code Required
\n"], ["607", "
Info Reporting (N1/N3) Trans Cannot Be Matched To A Claim (B1/B3)
\n"], ["608", "
Step Therapy/Alt Drug Therapy Req'd Prior To Submitted Prod Serv ID
\n"], ["CH", "
M/I Employer City Address
\n"], ["609", "
COB Claim Not Required, Patient Liability Amount Submitted Was Zero
\n"], ["610", "
Info Reporting Trans Matched to Reversed/Rejected Claim Under Part D
\n"], ["611", "
Supp Claim Was Matched To A Claim Covered By A Benefit Oth Than Part D
\n"], ["612", "
LTC Appropriate Dispensing Invalid Submission Clarification Code Combo
\n"], ["613", "
Packaging Methodology Or Dispensing Frequency M/I For LTC Short Cycle
\n"], ["614", "
Uppercase Character(s) Required
\n"], ["615", "
Basis Of Cost Determ Value 14 Req'd When Compound Ing Qty 0, Cost>$0
\n"], ["616", "
Submission Clarification Code 8 Req'd When Compound Ingredient Qty 0
\n"], ["617", "
Compound Ingredient Drug Cost Cannot Be Negative Amount
\n"], ["618", "
Submitted Prescriber's DEA Does Not Allow This Drug DEA Schedule
\n"], ["CI", "
M/I Employer State/Province Address
\n"], ["619", "
Prescriber Type 1 NPI Required
\n"], ["620", "
This Product/Service May Be Covered Under Medicare Part D
\n"], ["621", "
This Medicaid Patient Is Medicare Eligible
\n"], ["645", "
Repackaged product is not covered by the contract
\n"], ["646", "
Pat Not Eligible Due To Non Payment Of Premium. Pat To Contact Plan
\n"], ["647", "
Quantity Prescribed Required For CII Prescription
\n"], ["648", "
Qty Prescribed Does Not Match Qty Prescribed On Original Dispensing
\n"], ["649", "
Cumulative Qty For This Rx Number Exceeds Total Prescribed Qty
\n"], ["650", "
DOS More Than 60 Days From CII Dt Rx Written for LTC/Terminally Ill Pt
\n"], ["1K", "
M/I Patient Country Code
\n"], ["CJ", "
M/I Employer Zip Postal Zone
\n"], ["622", "
COB Claim not required, patient liability amount submitted was zero
\n"], ["623", "
M/I Authorized Representative Country Code
\n"], ["624", "
M/I Employer Country Code
\n"], ["625", "
M/I Entity Country Code
\n"], ["627", "
M/I Facility Country Code
\n"], ["628", "
M/I Patient ID Associated Country Code
\n"], ["629", "
M/I Pay to Country Code
\n"], ["630", "
M/I Prescriber Alternate ID Associated Country Code
\n"], ["631", "
M/I Prescriber ID Associated Country Code
\n"], ["632", "
M/I Prescriber Country Code
\n"], ["11", "
M/I Patient Relationship Code
\n"], ["CK", "
M/I Employer Phone Number
\n"], ["633", "
M/I Purchaser ID Associated Country Code
\n"], ["634", "
Authorized Representative Country Code Value Not Supported
\n"], ["635", "
Employer Country Code Value Not Supported
\n"], ["637", "
Entity Country Code Value Not Supported
\n"], ["638", "
Facility Country Code Value Not Supported
\n"], ["639", "
Patient ID Associated Country Code Value Not Supported
\n"], ["640", "
Pay to Country Code Value Not Supported
\n"], ["641", "
M/I Prescriber Alt ID Associated Country Code Value Not Supported
\n"], ["642", "
M/I Prescriber ID Associated Country Code Value Not Supported
\n"], ["643", "
M/I Prescriber Country Code Value Not Supported
\n"], ["CL", "
M/I Employer Contact Name
\n"], ["644", "
M/I Purchaser ID Associated Country Code Value Not Supported
\n"], ["651", "
REMS: Mandatory data element(s) missing
\n"], ["652", "
REMS: Prescriber not matched or may not be enrolled
\n"], ["653", "
REMS: Patient not matched or may not be enrolled
\n"], ["654", "
REMS: Pharmacy not matched or may not be enrolled
\n"], ["655", "
REMS: Multiple patient matches
\n"], ["656", "
REMS: Patient age not matched
\n"], ["657", "
REMS: Patient gender not matched
\n"], ["658", "
REMS: Pharmacy has not enrolled
\n"], ["659", "
REMS: Pharmacy has not renewed enrollment
\n"], ["CM", "
M/I Patient Street Address
\n"], ["660", "
REMS: Pharmacy has not submitted agreement form
\n"], ["661", "
REMS: Pharmacy has been suspended due to non-compliance
\n"], ["662", "
REMS: Prescriber has not enrolled
\n"], ["663", "
REMS: Prescriber has not completed a knowledge assessment
\n"], ["664", "
REMS: Prescriber has been suspended due to non-compliance
\n"], ["665", "
REMS: Excessive days supply
\n"], ["666", "
REMS: Insufficient days supply
\n"], ["667", "
REMS: Excessive dosage
\n"], ["668", "
REMS: Insufficient dosage
\n"], ["669", "
REMS: Refills not permitted
\n"], ["CN", "
M/I Patient City Address
\n"], ["670", "
REMS: Laboratory test results not documented
\n"], ["671", "
REMS: Laboratory test not conducted within specified time period
\n"], ["672", "
REMS: Dispensing not authorized due to laboratory test results
\n"], ["673", "
REMS: Prescriber counseling of patient not documented
\n"], ["674", "
REMS: Prescriber has not documented safe use conditions
\n"], ["675", "
REMS: Prescriber has not documented patient opioid tolerance
\n"], ["676", "
REMS: Prescriber has not documented patient contraceptive use
\n"], ["677", "
REMS: Lack of contraindicated therapy not documented
\n"], ["678", "
REMS: Step therapy not documented
\n"], ["679", "
REMS: Prescriber has not enrolled patient
\n"], ["CO", "
M/I Patient State/Province Address
\n"], ["680", "
REMS: Prescriber must renew patient enrollment
\n"], ["681", "
REMS: Patient enrollment requirements have not been met
\n"], ["682", "
REMS: Prescriber has not submitted patient agreement
\n"], ["683", "
REMS: Prescriber has not verified patient's reproductive potential
\n"], ["684", "
REMS: Patient has not documented safe use conditions
\n"], ["685", "
REMS: Patient has not documented completed education
\n"], ["686", "
REMS: Patient has not documented contraceptive use
\n"], ["687", "
REMS Administrator Denied
\n"], ["688", "
REMS: Service Billing Denied
\n"], ["689", "
PDMP Administrator Denied
\n"], ["CP", "
M/I Patient Zip/Postal Zone
\n"], ["690", "
PDMP: Pharmacy not contracted
\n"], ["691", "
PDMP: Pharmacy contract not renewed
\n"], ["692", "
PDMP: M/I Patient First Name
\n"], ["693", "
PDMP: M/I Patient Last Name
\n"], ["694", "
PDMP: M/I Patient Street Address
\n"], ["695", "
PDMP: M/I Patient City
\n"], ["696", "
PDMP: M/I Patient State or Province
\n"], ["697", "
PDMP: M/I Patient ZIP/Postal Code
\n"], ["698", "
PDMP: M/I Prescriber ID
\n"], ["699", "
PDMP: M/I Prescriber Last Name
\n"], ["CQ", "
M/I Patient Phone Number
\n"], ["700", "
PDMP: M/I Patient ID
\n"], ["701", "
PDMP: M/I Patient Date of Birth
\n"], ["702", "
PDMP: M/I Patient Gender
\n"], ["703", "
PDMP: M/I Prescription Origin Code
\n"], ["704", "
PDMP: M/I Scheduled Rx Serial Number
\n"], ["705", "
PDMP: M/I Product/Service ID
\n"], ["706", "
PDMP: M/I Compound Code
\n"], ["707", "
PDMP: M/I Patient Phone Number
\n"], ["708", "
PDMP: M/I Reported Adjudicated Program Type
\n"], ["769", "
Medicare PartD Pd claim found, Info Report Reversal/Rebill not matched
\n"], ["CR", "
M/I Carrier ID
\n"], ["770", "
Medicare Part D Pd claim not found, Info Report Reversal not processed
\n"], ["771", "
Compound contains unidentifiable ingredient; SCC override not allowed
\n"], ["772", "
Compound not payable due to non-covered ingredient;no override allowed
\n"], ["773", "
Prescriber Is Not Listed On Medicare Enrollment File
\n"], ["774", "
Prescriber Medicare Enrollment Period Is Outside Of Claim Date Of Serv
\n"], ["775", "
Pharmacy not listed within Medicare Fee For Service enrollment file
\n"], ["776", "
Pharmacy enrollment with Medicare Fee For Service has terminated
\n"], ["777", "
Plan's Prescriber data base not able to verify active state license
\n"], ["A3", "
This Product May Be Covered Under Hospice - Medicare A
\n"], ["A4", "
Prod May Be Covered Under Medicare-B Bndld Pymt ESRD Dialysis Facility
\n"], ["CT", "
Patient Social Security Number
\n"], ["710", "
Date Received After Requested Response Date
\n"], ["711", "
M/I Transmission Date
\n"], ["712", "
M/I Sending Entity Identifier
\n"], ["713", "
M/I Receiver ID
\n"], ["714", "
M/I Transmission File Type
\n"], ["715", "
M/I Transmission Type
\n"], ["716", "
Transmission File Type Not Supported
\n"], ["717", "
M/I Submission Number
\n"], ["718", "
M/I Audit Request Type
\n"], ["719", "
Audit Request Type Not Supported
\n"], ["DP", "
M/I DRUG TYPE OVERRIDE
\n"], ["720", "
M/I Service Provider Chain Code
\n"], ["721", "
M/I Entity Name
\n"], ["722", "
M/I Entity Contact First Name
\n"], ["723", "
M/I Entity Contact Last Name
\n"], ["724", "
M/I Entity Address Line 1
\n"], ["725", "
M/I Entity Address Line 2
\n"], ["726", "
M/I Entity City
\n"], ["727", "
M/I Entity State/Province Address
\n"], ["728", "
M/I Entity Zip/Postal Code
\n"], ["729", "
M/I Entity Fax Number
\n"], ["12", "
M/I Place of Service
\n"], ["DR", "
M/I Prescriber Last Name
\n"], ["730", "
M/I Entity Email
\n"], ["731", "
Header Response Status Not Supported for this Transmission File Type
\n"], ["732", "
Reject Code Not Supported for this Transmission File Type
\n"], ["733", "
M/I Claim Sequence Number
\n"], ["734", "
M/I Audit Control Identification
\n"], ["735", "
M/I Audit Range Qualifier
\n"], ["736", "
Audit Range Qualifier Not Supported for this Audit Request Type
\n"], ["737", "
M/I Audit Range Start
\n"], ["738", "
Audit Range Start Not Supported for this Audit Request Type
\n"], ["739", "
M/I Audit Range End
\n"], ["DQ", "
M/I Usual And Customary Charge
\n"], ["740", "
Audit Range End Not Supported for this Audit Request Type
\n"], ["741", "
Exceeds Range Start Limitations
\n"], ["742", "
Exceeds Range End Limitations
\n"], ["743", "
M/I Requested Response Date
\n"], ["744", "
Response Date Requires Rescheduling
\n"], ["745", "
M/I Estimated Arrival Time Description
\n"], ["746", "
Estimated Arrival Time Requires Rescheduling
\n"], ["747", "
M/I Audit Sponsor
\n"], ["748", "
Non-Matched Processor Control Number
\n"], ["749", "
M/I Audit Element Type 1
\n"], ["DS", "
M/I Postage Amount Claimed
\n"], ["750", "
M/I Audit Element Type 2
\n"], ["751", "
M/I Audit Element Type 3
\n"], ["752", "
M/I Audit Element Type 4
\n"], ["753", "
M/I Audit Element Type 5
\n"], ["754", "
Audit Element Type not allowable per State Regulation
\n"], ["755", "
Audit Element Type not required for dispensing
\n"], ["756", "
M/I Audit Element Response Type 1
\n"], ["757", "
M/I Audit Element Response Type 2
\n"], ["758", "
M/I Audit Element Response Type 3
\n"], ["759", "
M/I Audit Element Response Type 4
\n"], ["DT", "
M/I Special Packaging Indicator
\n"], ["760", "
M/I Audit Element Response Type 5
\n"], ["761", "
M/I Discrepancy Code 1
\n"], ["762", "
M/I Discrepancy Code 2
\n"], ["763", "
M/I Discrepancy Code 3
\n"], ["764", "
M/I Discrepancy Message
\n"], ["765", "
M/I Discrepancy Amount
\n"], ["766", "
Discrepancy Amount in excess of Claimed Amount
\n"], ["767", "
M/I Record Count
\n"], ["768", "
Pharmacy Location has closed
\n"], ["778", "
Invalid Transmission File Type
\n"], ["DU", "
M/I Gross Amount Due
\n"], ["779", "
Invalid Document Reference Number
\n"], ["780", "
M/I Transmission Time
\n"], ["781", "
Corrupted Transmission Control Number
\n"], ["782", "
M/I Sender ID
\n"], ["783", "
M/I Receiver ID
\n"], ["784", "
M/I File Type
\n"], ["785", "
M/I Submission Number
\n"], ["786", "
M/I Transmission Date
\n"], ["787", "
M/I Accumulator Balance Count
\n"], ["788", "
M/I Accumulator Network Indicator
\n"], ["DV", "
M/I Other Payer Amount Paid
\n"], ["789", "
M/I Accumulator Action Code
\n"], ["790", "
M/I Benefit Type
\n"], ["791", "
M/I In Network Status
\n"], ["792", "
Duplicate Record
\n"], ["793", "
Retry Limit Exceeded
\n"], ["794", "
Deductible Over Accumulated
\n"], ["795", "
Out Of Pocked Over Accumulated
\n"], ["796", "
Maximum Benefit Amount (CAP) Over Accumulated
\n"], ["797", "
Corrupted Transmission Control Number
\n"], ["798", "
SA Over Accumulated
\n"], ["DW", "
M/I Basis Of Days Supply Determination
\n"], ["799", "
LTC Over Accumulated
\n"], ["800", "
RXC Over Accumulated
\n"], ["801", "
M/I Total Amount Paid
\n"], ["802", "
M/I Amount of Copay
\n"], ["803", "
M/I Patient Pay Amount
\n"], ["804", "
M/I Amount Attributed to Product Selection/Brand
\n"], ["805", "
M/I Amount Attributed to Sales Tax
\n"], ["806", "
M/I Amount Attributed to Process Fee
\n"], ["807", "
M/I Invoiced Amount
\n"], ["808", "
M/I Penalty Amount
\n"], ["DX", "
M/I Patient Pay Amount Reported
\n"], ["809", "
Mismatched Original Authorization
\n"], ["810", "
M/I Partner Eligibility Data
\n"], ["811", "
Partner Eligibility Mismatch
\n"], ["812", "
M/I Record Length
\n"], ["813", "
M/I Action Code
\n"], ["814", "
Not Supported Accumulator Action Code
\n"], ["815", "
Balance Mismatch
\n"], ["816", "
Pharmacy Benefit Exclusion, May Be Covered Under Pt's Medical Benefit
\n"], ["817", "
Pharmacy Benefit Exclusion, Covered Under Patient's Medical Benefit
\n"], ["818", "
Medication Administration Not Covered, Plan Benefit Exclusion
\n"], ["DY", "
M/I Date Of Injury
\n"], ["819", "
Plan Enrollment File Indicates Medicare As Primary Coverage
\n"], ["820", "
Info Reporting Trans Mtchd to Rev/Rej Clm not Submitted Part D IIN PCN
\n"], ["821", "
Info Reporting Trans Mtchd to Pd Clm Not Submitted Part D IIN PCN
\n"], ["822", "
Drug Unrelated To The Terminal Illness &/Or Rel Cond. No Hospice Cov
\n"], ["823", "
Drug Is Benef Liability-Not Cov By Hospice. Hosp Non-Form. Chk Oth Cov
\n"], ["824", "
Multi-transaction transmission not allowed in current NCPDP standard
\n"], ["825", "
Claim Date Of Service Is Outside Of Product's FDA/NSDE Marketing Dates
\n"], ["826", "
Prescriber NPI Submitted Not Found Within Processor's NPI File
\n"], ["827", "
Pharm Serv Prov Is Temp Suspnded From Processing Clms By Payer/Process
\n"], ["828", "
Plan/Beneficiary Case Management Restriction In Place
\n"], ["DZ", "
M/I Claim/Reference ID
\n"], ["829", "
Clm Not Cov Due To Failure To Meet Part D Prescriber NPI Requirements
\n"], ["830", "
Workers' Comp Or P&C Adjuster Auth Required-Pt Must Contact Adjuster
\n"], ["831", "
Product Service ID Carve-Out, Bill Medicaid Fee For Service
\n"], ["832", "
Prescriber NPI Not Found - NPI, MEDICARE, RX Authority Not Validated
\n"], ["833", "
Accumulator Year Is Not Within ATBT Timeframe
\n"], ["834", "
M/I Provider First Name
\n"], ["835", "
M/I Provider Last Name
\n"], ["836", "
M/I Facility ID Qualifier
\n"], ["837", "
Facility ID Qualifier Value Not Supported
\n"], ["838", "
M/I Original Manufacturer Product ID
\n"], ["13", "
M/I Other Coverage Code
\n"], ["E1", "
M/I Product/Service ID Qualifier
\n"], ["839", "
M/I Original Manufacturer Product ID Qualifier
\n"], ["840", "
Original Manufacturer Product ID Qualifier Value Not Supported
\n"], ["841", "
Record is Locked
\n"], ["842", "
Record is Not Locked
\n"], ["843", "
M/I Transmission ID
\n"], ["844", "
M/I Other Payer Adjudicated Program Type
\n"], ["845", "
Other Payer Reconciliation ID Is Not Used For This Transaction Code
\n"], ["846", "
Benefit Stage Indicator Count Is Not Used For This Transaction Code
\n"], ["847", "
Benefit Stage Indicator Count Does Not Precede Benefit Stage Indicator
\n"], ["848", "
M/I Benefit Stage Indicator Count
\n"], ["E2", "
M/I Route of Administration
\n"], ["849", "
Benefit Stage Indicator Count Does Not Match Number of Repetitions
\n"], ["850", "
Benefit Stage Indicator Is Not Used For This Transaction Code
\n"], ["851", "
Benefit Stage Indicator Value Not Supported
\n"], ["852", "
M/I Benefit Stage Indicator
\n"], ["853", "
N Payer IIN Is Not Used For This Transaction Code
\n"], ["854", "
M/I N Payer IIN
\n"], ["855", "
Non-Matched N Payer IIN
\n"], ["856", "
N Payer Processor Control Number Is Not Used For This Transaction Code
\n"], ["857", "
M/I N Payer Processor Control Number
\n"], ["858", "
Non-Matched N Payer Processor Control Number
\n"], ["E3", "
M/I Incentive Amount Submitted
\n"], ["859", "
N Payer Group ID Is Not Used For This Transaction Code
\n"], ["860", "
M/I N Payer Group ID
\n"], ["861", "
Non-Matched N Payer Group ID
\n"], ["862", "
N Payer Cardholder ID Is Not Used For This Transaction Code
\n"], ["863", "
M/I N Payer Cardholder ID
\n"], ["864", "
N Payer Cardholder ID Is Not Covered
\n"], ["865", "
N Payer Adjudicated Program Type Is Not Used For This Transaction Code
\n"], ["866", "
M/I N Payer Adjudicated Program Type
\n"], ["867", "
N Payer Adjudicated Program Type Value Not Supported
\n"], ["868", "
M/I N Transaction Reconciliation ID
\n"], ["E4", "
M/I Reason For Service Code
\n"], ["869", "
M/I N Transaction Source Type
\n"], ["870", "
M/I Prescriber DEA Number
\n"], ["871", "
M/I Compound Level Of Complexity
\n"], ["872", "
Mismatch of Compound Level Complexity And Prep Environment Type
\n"], ["873", "
M/I Preparation Environment Type
\n"], ["874", "
M/I Preparation Environment Event Code
\n"], ["875", "
M/I Total Prescribed Quantity Remaining
\n"], ["876", "
Prescriptive Authority Restrictions Apply, Criteria Not Met
\n"], ["877", "
Service Provider ID Terminated On NPPES File
\n"], ["878", "
Service Provider ID Not Found On NPPES File
\n"], ["E5", "
M/I Professional Service Code
\n"], ["879", "
Service Provider ID Excluded From Receiving CMS Enrollment Data
\n"], ["880", "
M/I Submission Type Code
\n"], ["881", "
M/I Submission Type Code Count
\n"], ["882", "
M/I Do Not Dispense Before Date
\n"], ["883", "
Date of Service Prior To Do Not Dispense Before Date
\n"], ["884", "
M/I Multiple RX Order Group Reason Code
\n"], ["885", "
M/I Multiple RX Order Group ID
\n"], ["886", "
M/I Prescriber Place of Service
\n"], ["887", "
Prev Payer is Excluded Fed Health Care Progm Copay Assist Not Allowed
\n"], ["888", "
Beneficiary Is Enrolled In Excluded Federal Health Care Program
\n"], ["E6", "
M/I Result Of Service Code
\n"], ["889", "
Prescriber Not Enrolled in State Medicaid Program
\n"], ["890", "
Pharmacy Not Enrolled in State Medicaid Program
\n"], ["891", "
Days Supply Is Less Than Plan Minimum
\n"], ["892", "
Pharmacy Must Attest FDA REMS Requirements Have Been Met
\n"], ["893", "
Pharmacy Must Attest Required Patient Form Is On File
\n"], ["894", "
Pharmacy Must Attest Plan Medical Necessity Criteria Has Been Met
\n"], ["895", "
Allowed Number of Overrides Exhausted
\n"], ["896", "
Other Adjudicated Program Type Of Unknown Is Not Covered
\n"], ["897", "
M/I Regulatory Fee Count
\n"], ["898", "
M/I Regulatory Fee Type Code
\n"], ["E7", "
M/I Quantity Dispensed
\n"], ["899", "
M/I Other Payer Percentage Tax Exempt Indicator
\n"], ["900", "
M/I Other Payer Regulatory Fee Type Count
\n"], ["901", "
M/I Other Payer Regulatory Fee Type Code
\n"], ["902", "
M/I Other Payer Regulatory Fee Exempt Indicator
\n"], ["903", "
Regulatory Fee Count Not Used For This Transaction Code
\n"], ["904", "
Regulatory Fee Type Code Not Used For This Transaction Code
\n"], ["905", "
Other Payer Percent Tax Exempt Indicator Not Used For This Transaction
\n"], ["906", "
Other Payer Regulatory Fee Type Count Not Used For This Transaction
\n"], ["907", "
Other Payer Regulatory Fee Type Code Not Used For This Transaction
\n"], ["908", "
Other Payer Regulatory Fee Exempt Indicator Not Used This Transaction
\n"], ["E8", "
M/I Other Payer Date
\n"], ["909", "
Regulatory Fee Grouping Not Correct
\n"], ["910", "
Other Payer Regulatory Fee Grouping Not Correct
\n"], ["911", "
Regulatory Fee Count Does Not Match Number of Repetitions
\n"], ["912", "
Other Payer Regulatory Fee Type Count Does Not Match Repetition Number
\n"], ["913", "
Regulatory Fee Count Exceeds Number Of Occurrences Supported
\n"], ["914", "
Other Payer Regulatory Fee Type Count Exceeds Number Times Supported
\n"], ["915", "
Regulatory Fee Type Code Doesn't Precede Regulatory Fee Amnt Submitted
\n"], ["916", "
Other Payer Reg. Fee (OPRF) Type Doesn't Precede OPRF Exempt Indicator
\n"], ["917", "
Regulatory Fee Count Does Not Precede Regulatory Fee Type Code
\n"], ["918", "
Other Payer Regulatory Fee (OPRF) Count Doesn't Precede OPRF Type Code
\n"], ["M1", "
Patient Not Covered In This Aid Category
\n"], ["919", "
Regulatory Fee Type Code Value Not Supported
\n"], ["920", "
Other Payer Regulatory Fee Type Code Value Not Supported
\n"], ["921", "
Other Payer Regulatory Fee Exempt Indicator Value Not Supported
\n"], ["922", "
Morphine Milligram Equivalency (MME) Exceeds Limits
\n"], ["923", "
Morphine Milligram Equivalency (MME) Exceeds Limits For Patient Age
\n"], ["924", "
Cumulative Dose Exceeded Across Multiple Prescriptions
\n"], ["925", "
Initial Fill Days Supply Exceeds Limits
\n"], ["926", "
Initial Fill Days Supply Exceeds Limits For Patient Age
\n"], ["927", "
Days Supply Limitation For Product/Service For Patient Age
\n"], ["928", "
Cumulative Fills Exceed Limits
\n"], ["M2", "
Recipient Locked In
\n"], ["929", "
ID Submitted Is Associated With A Precluded Prescriber
\n"], ["930", "
ID Submitted Is Associated To A Precluded Pharmacy
\n"], ["942", "
M/I Species
\n"], ["943", "
DUR Reject - Pharmacy Override Using DUR/PPS Not Allowed
\n"], ["944", "
All Lots Of Drug/Product Recalled
\n"], ["945", "
High Dollar Amount Is Not Supported
\n"], ["946", "
Last Known 4RX Claim Date Submitted Too Old
\n"], ["979", "
Patient Locked Into Specific Prescriber(s)
\n"], ["980", "
Patient Locked Into Specific Pharmacy(s)
\n"], ["981", "
DOS for Remaining Fill Portion Exceeds Regulatory Time for Dispensing
\n"], ["14", "
M/I Eligibility Clarification Code
\n"], ["M3", "
Host PA/MC Error
\n"], ["982", "
Provide Pt Notice When Pt Care Delay Due to Claim Rej/Benefit Restrict
\n"], ["984", "
Bill Dual Elig. Medicare Part B Pt. Cost Share to Alt Medicaid Benefit
\n"], ["985", "
Beneficiary Has A Work Comp Medicare Set-Aside Arrangement (WCMSA)
\n"], ["DA1", "
M/I Employer Contact Last Name
\n"], ["DA2", "
M/I Employer Street Address Line 1
\n"], ["DA3", "
M/I Employer Street Address Line 2
\n"], ["DA4", "
M/I Employer Telephone Number Extension
\n"], ["DA5", "
M/I Facility Street Address Line 1
\n"], ["DA6", "
M/I Facility Street Address Line 2
\n"], ["M4", "
Prescription/Service Reference Number/Time Limit Exceeded
\n"], ["DA7", "
M/I Number of LTPAC Dispensing Events
\n"], ["DA8", "
M/I Patient Street Address Line 1
\n"], ["DA9", "
M/I Patient Street Address Line 2
\n"], ["DB1", "
M/I Reconciliation ID
\n"], ["DB2", "
M/I Subrogation Amount Requested
\n"], ["DB3", "
M/I Pay To Street Address Line 1
\n"], ["DB4", "
M/I Pay To Street Address Line 2
\n"], ["DB5", "
Facility ID Qualifier Does Not Precede Facility ID
\n"], ["DB6", "
M/I LTPAC Billing Methodology
\n"], ["DB7", "
LTPAC Billing Methodology Value Not Supported
\n"], ["M5", "
Requires Manual Claim
\n"], ["DB8", "
M/I LTPAC Dispense Frequency
\n"], ["DB9", "
LTPAC Dispense Frequency Value Not Supported
\n"], ["DC1", "
Original Manufacturer Product ID Qualifier Does Not Precede Product ID
\n"], ["DC2", "
Patient ID Associated Country Code is Not Used for this Trans Code
\n"], ["DC3", "
Patient Name Prefix is Not Used for this Transaction Code
\n"], ["DC4", "
Patient Name Suffix is Not Used for this Transaction Code
\n"], ["DC5", "
Prescriber Alt ID Assoc Country Code is Not Used for this Trans Code
\n"], ["DC6", "
Prescriber ID Associated Country Code is Not Used for this Trans Code
\n"], ["DC7", "
Reconciliation ID is Not Used for this Transaction Code
\n"], ["DC8", "
Submission Type Code Count is Not Used for this Transaction Code
\n"], ["M6", "
Host Eligibility Error
\n"], ["DC9", "
Submission Type Code Count Does Not Precede Submission Type Code
\n"], ["DD1", "
Submission Type Code Count Exceeds Number of Occurrences Supported
\n"], ["DD2", "
Submission Type Code Count Does Not Match Number of Repetitions
\n"], ["DD3", "
Patient ID Count Is Not Used for This Transaction Code
\n"], ["DD4", "
Patient ID Count Exceeds Number of Occurrences Supported
\n"], ["DD5", "
Patient ID Grouping is Incorrect
\n"], ["DD6", "
Patient Middle Name Is Not Used for This Transaction Code
\n"], ["DD7", "
Prescriber Middle Name Is Not Used for This Transaction Code
\n"], ["DD8", "
M/I Prescriber Street Address Line 1
\n"], ["DD9", "
M/I Prescriber Street Address Line 2
\n"], ["M7", "
Host Drug File Error
\n"], ["DE1", "
M/I Prescriber Telephone Number Extension
\n"], ["986", "
M/I Sex Assigned at Birth
\n"], ["987", "
Sex Assigned at Birth Value Not Supported
\n"], ["997", "
Assoc Rx/Svc Reference # Qualifier Does Not Precede Reference #
\n"], ["998", "
Benefit Stage Indicator Count Exceeds Number of Occurrences Supported
\n"], ["999", "
M/I Employer Contact First Name
\n"], ["DE2", "
Other Payer Info can contain financial fields or reject codes not both
\n"], ["DE3", "
Professional Service Not Covered - Plan/Benefit Exclusion
\n"], ["DE4", "
Prof Svc Code Req'd when Incentive Fee Submtd on Non-Vaccine Product
\n"], ["DE5", "
Hospice Nx Not Supported
\n"], ["M8", "
Host Provider File Error
\n"], ["DE6", "
Hospice Clinical Info Counter Does Not Match Trans Code Submitted
\n"], ["DE7", "
No Hospice Enrollment Found For This NPI
\n"], ["DE8", "
Hospice Rx/Service Reference Numb Does Not Match Trans Code Submitted
\n"], ["DE9", "
Member refusal of product - Contact plan only
\n"], ["DF1", "
Pharmacy locked out at member request - Contact plan only
\n"], ["DF2", "
Prescriber locked out at member request - Contact plan only
\n"], ["DF3", "
Reversal Request Submitted Out of Order for Coordinated Benefit
\n"], ["DF4", "
Invalid LTPAC Dispense Frequency & Submission Clarification Code Combo
\n"], ["DF5", "
Benefit Stage Indicator Grouping Incorrect
\n"], ["MZ", "
Error Overflow
\n"], ["DF6", "
Clinical Information Grouping Incorrect
\n"], ["DF7", "
Compound Ingredient Grouping Incorrect
\n"], ["DF8", "
Compound Ingredient Modifier Grouping Incorrect
\n"], ["DF9", "
Coordination of Benefits Grouping Incorrect
\n"], ["DG1", "
DUR Grouping Incorrect
\n"], ["DG2", "
Intermediary Grouping Incorrect
\n"], ["DG3", "
Other Payer Reject Grouping Incorrect
\n"], ["DG4", "
Procedure Modifier Grouping Incorrect
\n"], ["DG5", "
Additional Documentation Question Grouping Incorrect
\n"], ["DG6", "
Submission Clarification Code Grouping Incorrect
\n"], ["1C", "
M/I Smoker/Non-Smoker Code
\n"], ["DG7", "
Submission Type Code Grouping Incorrect
\n"], ["DG8", "
M/I Intermediary ID
\n"], ["DG9", "
M/I Intermediary ID Count
\n"], ["DH1", "
M/I Intermediary ID Country Code
\n"], ["DH2", "
M/I Intermediary ID State Province Address
\n"], ["DH3", "
M/I Intermediary ID Qualifier
\n"], ["DH4", "
M/I Intermediary ID Type Code
\n"], ["DH5", "
M/I Intermediary ID Type Entity
\n"], ["DH6", "
M/I Other Payer Reconciliation ID
\n"], ["DH7", "
Intermediary ID Count Does Not Match Number of Repetitions
\n"], ["1E", "
M/I Prescriber Location Code
\n"], ["DH8", "
Intermediary ID Count Does Not Precede Intermediary ID
\n"], ["DH9", "
Intermediary ID Qualifier Does Not Precede Intermediary ID
\n"], ["DI1", "
Intermediary Segment Incorrectly Formatted
\n"], ["DI2", "
Product/Service ID Qualifier (436-E1) Must Be 00 For Compounds.
\n"], ["DI3", "
Group Separator Is Not Used For This Version/Release
\n"], ["DI4", "
Submission Type Code Value Not Supported
\n"], ["DI5", "
Place of Service Value Not Supported
\n"], ["DI6", "
Species Value Not Supported
\n"], ["DI7", "
Prescriber Place of Service Value Not Supported
\n"], ["DI8", "
Other Payer Adjudicated Program Type Value Not Supported
\n"], ["2C", "
M/I Pregnancy Indicator
\n"], ["DI9", "
Other Payer Amount Paid Qualifier Value Not Supported
\n"], ["DJ1", "
Other Payer Percentage Tax Exempt Indicator Value Not Supported
\n"], ["DJ2", "
Procedure Modifier Code Value Not Supported
\n"], ["DJ3", "
Multiple Rx/Service Order Group Reason Code Value Not Supported
\n"], ["DJ4", "
Preparation Environment Type Value Not Supported
\n"], ["DJ5", "
Preparation Environment Event Code Value Not Supported
\n"], ["DJ6", "
Original Manufacturer Product ID Qualifier Value Not Supported
\n"], ["DJ7", "
LTPAC Dispense Frequency Value Not Supported
\n"], ["DJ8", "
LTPAC Billing Methodology Value Not Supported
\n"], ["DJ9", "
Compound Dosage Form Description Code Value Not Supported
\n"], ["15", "
M/I Date of Service
\n"], ["2E", "
M/I Primary Care Provider ID Qualifier
\n"], ["DK1", "
Compound Ingredient Modifier Code Value Not Supported
\n"], ["DK2", "
Compound Level of Complexity Value Not Supported
\n"], ["DK3", "
Intermediary ID Type Code Value Not Supported
\n"], ["DK4", "
Intermediary ID Type Entity Value Not Supported
\n"], ["DK5", "
Intermediary ID Qualifier Value Not Supported
\n"], ["DK6", "
Intermediary ID State/Province Address Value Not Supported
\n"], ["DK7", "
Intermediary ID Country Code Value Not Supported
\n"], ["DK8", "
Submission Type Code is Not Used for this Transaction Code
\n"], ["DK9", "
LTPAC Dispense Frequency is Not Used for this Transaction Code
\n"], ["DL1", "
LTPAC Billing Methodology is Not Used for this Transaction Code
\n"], ["3A", "
M/I Request Type
\n"], ["DL2", "
Number of LTPAC Dispensing Events Not Used for this Transaction Code
\n"], ["DL3", "
Multiple Rx/Service Order Group Reason Code Not Used for Transaction
\n"], ["DL4", "
Total Prescribed Quantity Remaining Not Used for This Transaction Code
\n"], ["DL5", "
Preparation Environment Type Not Used for This Transaction Code
\n"], ["DL6", "
Preparation Environment Event Code Not Used for This Transaction Code
\n"], ["DL7", "
Original Manufacturer Product ID Qualifier Not Used for Transaction
\n"], ["DL8", "
Original Manufacturer Product ID Not Used for This Transaction Code
\n"], ["DL9", "
LTPAC Dispense Frequency Not Used for This Transaction Code
\n"], ["DM1", "
LTPAC Billing Methodology Not Used for This Transaction Code
\n"], ["DM2", "
Number of LTPAC Dispensing Events Not Used for This Transaction Code
\n"], ["3B", "
M/I Request Period Date-Begin
\n"], ["DM3", "
Do Not Dispense Before Date Not Used for This Transaction Code
\n"], ["DM4", "
Subrogation Amount Requested Not Used for This Transaction Code
\n"], ["DM5", "
Other Payer Adjudicated Program Type Not Used for This Transaction
\n"], ["DM6", "
Other Payer Reconciliation ID Not Used for This Transaction Code
\n"], ["DM7", "
Intermediary Segment Not Used for This Transaction Code
\n"], ["DM8", "
Last Known 4Rx Segment Not Used for This Transaction Code
\n"], ["DM9", "
N Transaction Payer Identification Segment Not Used for Transaction
\n"], ["DN1", "
Minimum Quantity Limit Not Met
\n"], ["DN2", "
Claim for Non-Humans Not Covered - Plan/Benefit Exclusion
\n"], ["DN3", "
Non-Matched Hospice Prescription/Service Reference Number
\n"], ["3C", "
M/I Request Period Date-End
\n"], ["DN4", "
PGx: Dispensing Not Authorized Due to PGx Lab Test Results.
\n"], ["DN5", "
Multiple Rx/Service Order Group ID Is Not Used For This Transaction
\n"], ["DN6", "
M/I N Transaction Payer Identification Segment
\n"], ["DN7", "
N Transaction Payer Identification Segment Incorrectly Formatted
\n"], ["DN8", "
N Transaction Payer Identification Segment Required For Adjudication
\n"], ["DN9", "
Invalid Submission Clarification Code Combination
\n"], ["DO1", "
Beneficiary is not a participant in this Medicare Rx Payment Plan
\n"], ["DO2", "
Matching Medicare Part D Claim not found to allow processing Pymt Plan
\n"], ["DO3", "
This claim is not eligible for Medicare Prescription Payment Plan.
\n"], ["DO4", "
Oth Payer-Pt Resp Not-Supported, Plan only requires Oth Payer Amt Pd
\n"], ["3D", "
M/I Basis Of Request
\n"], ["DO5", "
DUR Conflict. Limited override at pharmacy. Prior auth may be needed.
\n"], ["DO6", "
Prescription Required. Claim without an associated Rx is not covered.
\n"], ["DO7", "
M/I Transmission Time
\n"], ["3E", "
M/I Authorized Representative First Name
\n"], ["3F", "
M/I Authorized Representative Last Name
\n"], ["3G", "
M/I Authorized Representative Street Address
\n"], ["3H", "
M/I Authorized Representative City Address
\n"], ["3J", "
M/I Authorized Representative State/Province Address
\n"], ["16", "
M/I Prescription/Service Reference Number
\n"], ["3K", "
M/I Authorized Representative Zip/Postal Zone
\n"], ["3M", "
M/I Prescriber Phone Number
\n"], ["3N", "
M/I Prior Authorized Number-Assigned
\n"], ["3P", "
M/I Authorization Number
\n"], ["3R", "
Prior Authorization Not Required
\n"], ["3S", "
M/I Prior Authorization Supporting Documentation
\n"], ["3T", "
Active Prior Auth Exists Resubmit At Expiration Of Prior Auth
\n"], ["3W", "
Prior Authorization In Process
\n"], ["3X", "
Authorization Number Not Found
\n"], ["3Y", "
Prior Authorization Denied
\n"], ["17", "
M/I Fill Number
\n"], ["4C", "
M/I Coordination Of Benefits/Other Payments Count
\n"], ["4E", "
M/I Primary Care Provider Last Name
\n"], ["5C", "
M/I Other Payer Coverage Type
\n"], ["5E", "
M/I Other Payer Reject Count
\n"], ["6C", "
M/I Other Payer ID Qualifier
\n"], ["6E", "
M/I Other Payer Reject Code
\n"], ["7C", "
M/I Other Payer ID
\n"], ["7E", "
M/I DUR/PPS Code Counter
\n"], ["8C", "
M/I Facility ID
\n"], ["8E", "
M/I DUR/PPS Level Of Effort
\n"], ["18", "
M/I Metric Quantity
\n"], ["AA", "
Patient Spenddown Not Met
\n"], ["AB", "
Date Written Is After Date Filled
\n"], ["AC", "
Product Not Covered Non-Participating Manufacturer
\n"], ["AD", "
Billing Provider Not Eligible To Bill This Claim Type
\n"], ["AE", "
QMB (Qualified Medicare Beneficiary)-Bill Medicare
\n"], ["AF", "
Patient Enrolled Under Managed Care
\n"], ["AG", "
Days Supply Limitation For Product/Service
\n"], ["AH", "
Unit Dose Packaging Only Payable For Nursing Home Recipients
\n"], ["AJ", "
Generic Drug Required
\n"], ["AK", "
M/I Software Vendor/Certification ID
\n"], ["19", "
M/I Days Supply
\n"], ["AM", "
M/I Segment Identification
\n"], ["A9", "
M/I Transaction Count
\n"], ["BE", "
M/I Professional Service Fee Submitted
\n"], ["B2", "
M/I Service Provider ID Qualifier
\n"], ["CW", "
M/I Alternate ID
\n"], ["CX", "
M/I Patient ID Qualifier
\n"], ["CY", "
M/I Patient ID
\n"], ["CZ", "
M/I Employer ID
\n"], ["DC", "
M/I Dispensing Fee Submitted
\n"], ["DN", "
M/I Basis Of Cost Determination
\n"], ["02", "
M/I Version/Release Number
\n"], ["20", "
M/I Compound Code
\n"], ["EA", "
M/I Originally Prescribed Product/Service Code
\n"], ["EB", "
M/I Originally Prescribed Quantity
\n"], ["EC", "
M/I Compound Ingredient Component Count
\n"], ["ED", "
M/I Compound Ingredient Quantity
\n"], ["EE", "
M/I Compound Ingredient Drug Cost
\n"], ["EF", "
M/I Compound Dosage Form Description Code
\n"], ["EG", "
M/I Compound Dispensing Unit Form Indicator
\n"], ["EH", "
M/I Compound Route of Administration
\n"], ["EJ", "
M/I Originally Prescribed Product/Service ID Qualifier
\n"], ["EK", "
M/I Scheduled Prescription ID Number
\n"], ["21", "
M/I Product/Service ID
\n"], ["EM", "
M/I Prescription/Service Reference Number Qualifier
\n"], ["EN", "
M/I Associated Prescription/Service Reference Number
\n"], ["Ep", "
M/I Associated Prescription/Service Date
\n"], ["ER", "
M/I Procedure Modifier Code
\n"], ["ET", "
M/I Quantity Prescribed
\n"], ["EU", "
M/I Prior Authorization Type Code
\n"], ["EV", "
M/I Prior Authorization ID Submitted
\n"], ["EW", "
M/I Intermediary Authorization Type ID
\n"], ["EX", "
M/I Intermediary Authorization ID
\n"], ["EY", "
M/I Provider ID Qualifier
\n"], ["22", "
M/I Dispense As Written (DAW)/Product Selection Code
\n"], ["EZ", "
M/I Prescriber ID Qualifier
\n"], ["E9", "
M/I Provider ID
\n"], ["FO", "
M/I Plan ID
\n"], ["GE", "
M/I Percentage Sales Tax Amount Submitted
\n"], ["HA", "
M/I Regulatory Fee Amount Submitted
\n"], ["HB", "
M/I Other Payer Amount Paid Count
\n"], ["HC", "
M/I Other Payer Amount Paid Qualifier
\n"], ["HD", "
M/I Dispensing Status
\n"], ["HE", "
M/I Percentage Sales Tax Rate Submitted
\n"], ["HF", "
M/I Quantity Intended To Be Dispensed
\n"], ["23", "
M/I Ingredient Cost Submitted
\n"], ["HG", "
M/I Days Supply Intended To Be Dispensed
\n"], ["H1", "
M/I Measurement Time
\n"], ["H2", "
M/I Measurement Dimension
\n"], ["H3", "
M/I Measurement Unit
\n"], ["H4", "
M/I Measurement Value
\n"], ["H5", "
M/I Primary Care Provider Location Code
\n"], ["H6", "
M/I DUR Co-Agent ID
\n"], ["H7", "
M/I Other Amount Claimed Submitted Count
\n"], ["H8", "
M/I Other Amount Claimed Submitted Qualifier
\n"], ["H9", "
M/I Other Amount Claimed Submitted
\n"], ["24", "
M/I SALES TAX
\n"], ["JE", "
M/I Percentage Sales Tax Basis Submitted
\n"], ["J9", "
M/I DUR Co-Agent ID Qualifier
\n"], ["KE", "
M/I Coupon Type
\n"], ["ME", "
M/I Coupon Number
\n"], ["NE", "
M/I Coupon Value Amount
\n"], ["NN", "
Transaction Rejected At Switch Or Intermediary
\n"], ["PA", "
PA Exhausted/Not Renewable
\n"], ["PB", "
Invalid Transaction Count For This Transaction Code
\n"], ["PC", "
M/I Request Claim Segment
\n"], ["PD", "
M/I Request Clinical Segment
\n"], ["25", "
M/I Prescriber ID
\n"], ["PE", "
M/I Request Coordination Of Benefits/Other Payments Segment
\n"], ["PF", "
M/I Request Compound Segment
\n"], ["PG", "
M/I Request Coupon Segment
\n"], ["PH", "
M/I Request DUR/PPS Segment
\n"], ["PJ", "
M/I Request Insurance Segment
\n"], ["PK", "
M/I Request Patient Segment
\n"], ["PM", "
M/I Request Pharmacy Provider Segment
\n"], ["PN", "
M/I Request Prescriber Segment
\n"], ["PP", "
M/I Request Pricing Segment
\n"], ["PR", "
M/I Request Prior Authorization Segment
\n"], ["26", "
M/I Unit Of Measure
\n"], ["PS", "
M/I Transaction Header Segment
\n"], ["PT", "
M/I Request Worker's Compensation Segment
\n"], ["PV", "
Non-Matched Associated Prescription/Service Date
\n"], ["PW", "
Employer ID Not Covered
\n"], ["PX", "
Other Payer ID Not Covered
\n"], ["PY", "
Non-Matched Unit Form/Route of Administration
\n"], ["PZ", "
Non-Matched Unit Of Measure To Product/Service ID
\n"], ["P1", "
Associated Prescription/Service Reference Number Not Found
\n"], ["P2", "
Clinical Information Counter Out Of Sequence
\n"], ["P3", "
Compound Ingredient Component Count Doesn't Match # Of Repetitions
\n"], ["27", "
Product Identifier not FDA/NSDE Listed
\n"], ["P4", "
COB/Other Payments Count Does Not Match Number Of Repetitions
\n"], ["P5", "
Coupon Expired
\n"], ["P6", "
Date Of Service Prior To Date Of Birth
\n"], ["P7", "
Diagnosis Code Count Does Not Match Number Of Repetitions
\n"], ["P8", "
DUR/PPS Code Counter Out Of Sequence
\n"], ["P9", "
Field Is Non-Repeatable
\n"], ["RA", "
PA Reversal Out Of Order
\n"], ["RB", "
Multiple Partials Not Allowed
\n"], ["RC", "
Different Drug Entity Between Partial & Completion
\n"], ["RD", "
Mismatched Cardholder/Group ID-Partial To Completion
\n"], ["28", "
M/I Date Prescription Written
\n"], ["RE", "
M/I Compound Product ID Qualifier
\n"], ["RF", "
Improper Order Of 'Dispensing Status' Code On Partial Fill Transaction
\n"], ["RG", "
M/I Associated Rx/Service Reference # On Completion Transaction
\n"], ["RH", "
M/I Associated Prescription/Service Date On Completion Transaction
\n"], ["RJ", "
Associated Partial Fill Transaction Not On File
\n"], ["RK", "
Partial Fill Transaction Not Supported
\n"], ["RM", "
Compl Trans Not Permitted With Same 'Date Of Service' As Partial Trans
\n"], ["RN", "
Plan Limits Exceeded On Intended Partial Fill Field Limitations
\n"], ["RP", "
Out Of Sequence 'P' Reversal On Partial Fill Transaction
\n"], ["RS", "
M/I Associated Prescription/Service Date On Partial Transaction
\n"], ["29", "
M/I Number Of Refills Authorized
\n"], ["RT", "
M/I Associated Prescription/Service Reference Number On Partial Trans
\n"], ["RU", "
Mandatory Elements Must Occur Before Optional Data Elements In Segment
\n"], ["R1", "
Other Amount Claimed Submitted Count Does Not Match # of Repetitions
\n"], ["R2", "
Other Payer Reject Count Does Not Match Number Of Repetitions
\n"], ["R3", "
Procedure Modifier Code Count Does Not Match Number Of Repetitions
\n"], ["R4", "
Procedure Modifier Code Invalid For Product/Service ID
\n"], ["R5", "
Product/Service ID Must Be Zero When Product/Service ID Qual Equals 06
\n"], ["R6", "
Product/Service Not Appropriate For This Location
\n"], ["R7", "
Repeating Segment Not Allowed In Same Transaction
\n"], ["R8", "
Syntax Error
\n"], ["03", "
M/I Transaction Code
\n"], ["30", "
Reversal request outside processor reversal window
\n"], ["R9", "
Value In Gross Amount Due Does Not Follow Pricing Formulae
\n"], ["SE", "
M/I Procedure Modifier Code Count
\n"], ["TE", "
Missing/Invalid Compound Product ID
\n"], ["UE", "
M/I Compound Ingredient Basis Of Cost Determination
\n"], ["VE", "
M/I Diagnosis Code Count
\n"], ["WE", "
M/I Diagnosis Code Qualifier
\n"], ["XE", "
M/I Clinical Information Counter
\n"], ["ZE", "
M/I Measurement Date
\n"], ["*95", "
The Clearinghous did not respond in time
\n"], ["*96", "
Scheduled Downtime
\n"], ["31", "
No matching paid claim found for reversal request
\n"], ["*97", "
Payor Unavailable
\n"], ["*98", "
Connection To Payer Is Down
\n"], ["*95", "
The Clearinghouse Did Not Respond In Time.
\n"], ["*97", "
Payer Unavailable
\n"], ["1R", "
Version/Release Value Not Supported
\n"], ["1S", "
Transaction Code/Type Value Not Supported
\n"], ["1T", "
PCN Must Contain Processor/Payer Assigned Value
\n"], ["1U", "
Transaction Count Does Not Match Number of Transactions
\n"], ["1V", "
Multiple Transactions Not Supported
\n"], ["1W", "
Multi-Ingredient Compound Must Be A Single Transaction
\n"], ["32", "
M/I Level Of Service
\n"], ["1X", "
Vendor Not Certified For Processor/Payer
\n"], ["1Y", "
Claim Segment Required For Adjudication
\n"], ["1Z", "
Clinical Segment Required For Adjudication
\n"], ["2A", "
M/I Medigap ID
\n"], ["2B", "
M/I Medicaid Indicator
\n"], ["2D", "
M/I Provider Accept Assignment Indicator
\n"], ["2G", "
M/I Compound Ingredient Modifier Code Count
\n"], ["2H", "
M/I Compound Ingredient Modifier Code
\n"], ["2J", "
M/I Prescriber First Name
\n"], ["2K", "
M/I Prescriber Street Address
\n"], ["33", "
M/I Prescription Origin Code
\n"], ["2M", "
M/I Prescriber City Address
\n"], ["2N", "
M/I Prescriber State/Province Address
\n"], ["2P", "
M/I Prescriber Zip/Postal Zone
\n"], ["2Q", "
M/I Additional Documentation Type ID
\n"], ["2R", "
M/I Length of Need
\n"], ["2S", "
M/I Length of Need Qualifier
\n"], ["2T", "
M/I Prescriber/Supplier Date Signed
\n"], ["2U", "
M/I Request Status
\n"], ["2V", "
M/I Request Period Begin Date
\n"], ["2W", "
M/I Request Period Recert/Revised Date
\n"], ["34", "
M/I Submission Clarification Code
\n"], ["2X", "
M/I Supporting Documentation
\n"], ["2Z", "
M/I Question Number/Letter Count
\n"], ["3Q", "
M/I Facility Name
\n"], ["3U", "
M/I Facility Street Address
\n"], ["3V", "
M/I Facility State/Province Address
\n"], ["4B", "
M/I Question Number/Letter
\n"], ["4D", "
M/I Question Percent Response
\n"], ["4G", "
M/I Question Date Response
\n"], ["4H", "
M/I Question Dollar Amount Response
\n"], ["4J", "
M/I Question Numeric Response
\n"], ["35", "
M/I Primary Care Provider ID
\n"], ["4K", "
M/I Question Alphanumeric Response
\n"], ["4M", "
Compound Ingredient Modifier Code Count Doesn't Match # of Repetitions
\n"], ["4N", "
Question Number/Letter Count Does Not Match Number of Repetitions
\n"], ["4P", "
Question Number/Letter Not Valid for Identified Document
\n"], ["4Q", "
Question Response Not Appropriate for Question Number/Letter
\n"], ["4R", "
Required Question Num/Letter Response for Indicated Document Missing
\n"], ["4S", "
Compound Product ID Requires a Modifier Code
\n"], ["4T", "
M/I Additional Documentation Segment
\n"], ["4W", "
Must Fill Through Specialty Pharmacy
\n"], ["4X", "
M/I Patient Residence
\n"], ["36", "
M/I Clinic ID
\n"], ["4Y", "
Patient Residence Value Not Supported
\n"], ["4Z", "
Place of Service Not Supported By Plan
\n"], ["5J", "
M/I Facility City Address
\n"], ["6D", "
M/I Facility Zip/Postal Zone
\n"], ["6G", "
COB/Other Payments Segment Required For Adjudication
\n"], ["6H", "
Coupon Segment Required For Adjudication
\n"], ["6J", "
Insurance Segment Required For Adjudication
\n"], ["6K", "
Patient Segment Required For Adjudication
\n"], ["6M", "
Pharmacy Provider Segment Required For Adjudication
\n"], ["6N", "
Prescriber Segment Required For Adjudication
\n"], ["37", "
(FUTURE USE)
\n"], ["6P", "
Pricing Segment Required For Adjudication
\n"], ["6Q", "
Prior Authorization Segment Required For Adjudication
\n"], ["6R", "
Worker's Compensation Segment Required For Adjudication
\n"], ["6S", "
Transaction Segment Required For Adjudication
\n"], ["6T", "
Compound Segment Required For Adjudication
\n"], ["6U", "
Compound Segment Incorrectly Formatted
\n"], ["6V", "
Multi-ingredient Compounds Not Supported
\n"], ["6W", "
DUR/PPS Segment Required For Adjudication
\n"], ["6X", "
DUR/PPS Segment Incorrectly Formatted
\n"], ["6Y", "
Not Authorized To Submit Electronically
\n"], ["38", "
M/I Basis Of Cost Determination
\n"], ["6Z", "
Provider Not Eligible To Perform Service/Dispense Product
\n"], ["7A", "
Provider Does Not Match Authorization On File
\n"], ["7B", "
Service Provider ID Qualifier Value Not Supported For Processor/Payer
\n"], ["7D", "
Non-Matched DOB
\n"], ["7G", "
Future Date Not Allowed For DOB
\n"], ["7H", "
Non-Matched Gender Code
\n"], ["7J", "
Patient Relationship Code Value Not Supported
\n"], ["7K", "
Discrepancy Between Other Coverage Code And Other Payer Amount
\n"], ["7M", "
Discrepancy Between Other Coverage Code & Other Coverage Info On File
\n"], ["7N", "
Patient ID Qualifier Value Not Supported
\n"], ["39", "
M/I Diagnosis Code
\n"], ["7P", "
COB/Other Payments Count Exceeds Number of Supported Payers
\n"], ["7Q", "
Other Payer ID Qualifier Value Not Supported
\n"], ["7R", "
Other Payer Amount Paid Count Exceeds Number of Supported Groupings
\n"], ["7S", "
Other Payer Amount Paid Qualifier Value Not Supported
\n"], ["7T", "
Quantity Intended To Be Dispensed Required For Partial Fill Trans
\n"], ["7U", "
Days Supply Intended To Be Dispensed Required For Partial Fill Trans
\n"], ["7V", "
Duplicate Refills
\n"], ["7W", "
Refills Exceed allowable Refills
\n"], ["7X", "
Days Supply Exceeds Plan Limitation
\n"], ["7Y", "
Compounds Not Covered
\n"], ["04", "
M/I Processor Control Number
\n"], ["40", "
Pharmacy Not Contracted With Plan On Date Of Service
\n"], ["7Z", "
Compound Requires Two Or More Ingredients
\n"], ["8A", "
Compound Requires At Least One Covered Ingredient
\n"], ["8B", "
Compound Segment Missing On A Compound Claim
\n"], ["8D", "
Compound Segment Present On A Non-Compound Claim
\n"], ["8G", "
Product/Service ID (407-D7) Must Be A Single Zero '0' For Compounds
\n"], ["8H", "
Product/Service Only Covered On Compound Claim
\n"], ["8J", "
Incorrect Product/Service ID For Processor/Payer
\n"], ["8K", "
DAW Code Value Not Supported
\n"], ["8M", "
Sum Of Compound Ingredient Costs Does Not Equal Ingredient Cost
\n"], ["8N", "
Future Date Prescription Written Not Allowed
\n"], ["41", "
Submit Bill To Other Processor Or Primary Payer
\n"], ["8P", "
Date Written Different On Previous Filling
\n"], ["8Q", "
Excessive Refills Authorized
\n"], ["8R", "
Submission Clarification Code Value Not Supported
\n"], ["8S", "
Basis Of Cost Determination Value Not Supported
\n"], ["8T", "
U&C Must Be Greater Than Zero
\n"], ["8U", "
GAD Must Be Greater Than Zero
\n"], ["8V", "
Negative Dollar Amount Is Not Supported In Other Payer Amount Paid
\n"], ["8W", "
Discrepancy Between Other Coverage Code and Other Payer Amount Paid
\n"], ["8X", "
Collection From Cardholder Not Allowed
\n"], ["8Y", "
Excessive Amount Collected
\n"], ["42", "
Plan's Prescriber database indicates Prescriber ID is inactive/expired
\n"], ["8Z", "
Product/Service ID Qualifier Value Not Supported
\n"], ["9B", "
Reason For Service Code Value Not Supported
\n"], ["9C", "
Professional Service Code Value Not Supported
\n"], ["9D", "
Result Of Service Code Value Not Supported
\n"], ["9E", "
Quantity Does Not Match Dispensing Unit
\n"], ["9G", "
Quantity Dispensed Exceeds Maximum Allowed
\n"], ["9H", "
Quantity Not Valid For Product/Service ID Submitted
\n"], ["9J", "
Future Other Payer Date Not Allowed
\n"], ["9K", "
Compound Ingredient Component Cnt Exceeds Num Of Ingredients Supported
\n"], ["9M", "
Minimum Of Two Ingredients Required
\n"], ["43", "
Plan's database Indicates Submitted Prescriber DEA# Inactive/Expired
\n"], ["9N", "
Compound Ingredient Quantity Exceeds Maximum Allowed
\n"], ["9P", "
Compound Ingredient Drug Cost Must Be Greater Than Zero
\n"], ["9Q", "
Route Of Administration Submitted Not Covered
\n"], ["9R", "
Prescription/Service Reference Number Qualifier Submitted Not Covered
\n"], ["9S", "
Future Associated Prescription/Service Date Not Allowed
\n"], ["9T", "
Prior Authorization Type Code Submitted Not Covered
\n"], ["9U", "
Provider ID Qualifier Submitted Not Covered
\n"], ["9V", "
Prescriber ID Qualifier Submitted Not Covered
\n"], ["9W", "
DUR/PPS Code Counter Exceeds Number Of Occurrences Supported
\n"], ["9X", "
Coupon Type Submitted Not Covered
\n"], ["44", "
Plan's database Indicates Submitted Prescriber DEA# Not Found
\n"], ["9Y", "
Compound Product ID Qualifier Submitted Not Covered
\n"], ["9Z", "
Duplicate Product ID In Compound
\n"], ["AQ", "
M/I Facility Segment
\n"], ["A5", "
Not Covered Under Part D Law
\n"], ["A6", "
This Product/Service May Be Covered Under Medicare Part B
\n"], ["A7", "
M/I Internal Control Number
\n"], ["BA", "
Compound Basis of Cost Determination Submitted Not Covered
\n"], ["BB", "
Diagnosis Code Qualifier Submitted Not Covered
\n"], ["BC", "
Future Measurement Date Not Allowed
\n"], ["BD", "
Sender Not Authorized To Submit File Type
\n"], ["45", "
(FUTURE USE)
\n"], ["BF", "
M/I File Type
\n"], ["BG", "
Sender ID Not Certified For Processor/Payer
\n"], ["BH", "
M/I Sender ID
\n"], ["BJ", "
Transmission Type Submitted Not Supported
\n"], ["BK", "
M/I Transmission Type
\n"], ["BM", "
M/I Narrative Message
\n"], ["EP", "
M/I Associated Prescription/Service Date
\n"], ["G1", "
M/I Compound Type
\n"], ["G2", "
M/I CMS Part D Defined Qualified Facility
\n"], ["G4", "
Prescriber must contact plan
\n"], ["46", "
Plan database-Submitted Prescriber DEA# Doesn't Allow This Drug Class
\n"], ["G5", "
Pharmacist must contact plan
\n"], ["G6", "
Pharmacy Not Contracted in Specialty Network
\n"], ["G7", "
Pharmacy Not Contracted in Home Infusion Network
\n"], ["G8", "
Pharmacy Not Contracted in Long Term Care Network
\n"], ["G9", "
Pharmacy Not Contracted in 90 Day Retail Network
\n"], ["HN", "
M/I Patient E-Mail Address
\n"], ["K5", "
M/I Transaction Reference Number
\n"], ["MG", "
M/I Other Payer BIN Number
\n"], ["MH", "
M/I Other Payer Processor Control Number
\n"], ["MJ", "
M/I Other Payer Group ID
\n"], ["47", "
(FUTURE USE)
\n"], ["MK", "
Non-Matched Other Payer BIN Number
\n"], ["MM", "
Non-Matched Other Payer Processor Control Number
\n"], ["MN", "
Non-Matched Other Payer Group ID
\n"], ["MP", "
Other Payer Cardholder ID Not Covered
\n"], ["MR", "
Product Not On Formulary
\n"], ["MS", "
More than 1 Cardholder Found - Narrow Search Criteria
\n"], ["MT", "
M/I Patient Assignment Indicator
\n"], ["MU", "
M/I Benefit Stage Count
\n"], ["MV", "
M/I Benefit Stage Qualifier
\n"], ["MW", "
M/I Benefit Stage Amount
\n"], ["48", "
(FUTURE USE)
\n"], ["MX", "
Benefit Stage Count Does Not Match Number Of Repetitions
\n"], ["NP", "
M/I Other Payer-Patient Responsibility Amount Qualifier
\n"], ["NQ", "
M/I Other Payer-Patient Responsibility Amount
\n"], ["NR", "
M/I Other Payer-Patient Responsibility Amount Count
\n"], ["NU", "
M/I Other Payer Cardholder ID
\n"], ["NV", "
M/I Delay Reason Code
\n"], ["NX", "
M/I Submission Clarification Code Count
\n"], ["N1", "
No patient match found
\n"], ["N3", "
M/I Medicaid Paid Amount
\n"], ["N4", "
M/I Medicaid Subrogation Internal Ctrl Number/Transaction Ctrl Number
\n"], ["49", "
(FUTURE USE)
\n"], ["N5", "
M/I Medicaid ID Number
\n"], ["N6", "
M/I Medicaid Agency Number
\n"], ["N7", "
Use Prior Authorization ID Provided During Transition Period
\n"], ["N8", "
Use Prior Authorization ID Provided For Emergency Fill
\n"], ["N9", "
Use Prior Authorization ID Provided For Level of Care Change
\n"], ["PQ", "
M/I Narrative Segment
\n"], ["RL", "
Transitional Benefit/Resubmit Claim
\n"], ["RV", "
Multiple Reversals Per Transmission Not Supported
\n"], ["SF", "
Other Payer Amount Paid Count Does Not Match Number Of Repetitions
\n"], ["SG", "
Submission Clarification Code Count Doesn't Match # of Repetitions
\n"], ["05", "
M/I Service Provider Number
\n"], ["50", "
Non-Matched Pharmacy Number
\n"], ["SH", "
Other Payer-Patient Resp Amount Count Doesn't Match # of Repetitions
\n"], ["TN", "
Emergency Fill/Resubmit Claim
\n"], ["TP", "
Level of Care Change/Resubmit Claim
\n"], ["TQ", "
Dosage Exceeds Product Labeling Limit
\n"], ["TR", "
M/I Billing Entity Type Indicator
\n"], ["TS", "
M/I Pay To Qualifier
\n"], ["TT", "
M/I Pay To ID
\n"], ["TU", "
M/I Pay To Name
\n"], ["TV", "
M/I Pay To Street Address
\n"], ["TW", "
M/I Pay To City Address
\n"], ["51", "
Non-Matched Group ID
\n"], ["TX", "
M/I Pay to State/Province Address
\n"], ["TY", "
M/I Pay To Zip/Postal Zone
\n"], ["TZ", "
M/I Generic Equivalent Product ID Qualifier
\n"], ["UA", "
M/I Generic Equivalent Product ID
\n"], ["UU", "
DAW 0 cannot be submitted on a multi-source drug w/available generics
\n"], ["UZ", "
Other Payer Coverage Type required on reversals to downstream payers
\n"], ["U7", "
M/I Pharmacy Service Type
\n"], ["VA", "
Pay To Qualifier Value Not Supported
\n"], ["VB", "
Generic Equivalent Product ID Qualifier Value Not Supported
\n"], ["VC", "
Pharmacy Service Type Value Not Supported
\n"], ["52", "
Non-Matched Cardholder ID
\n"], ["VD", "
Eligibility Search Time Frame Exceeded
\n"], ["ZA", "
The COB/Other Payments Segment is mandatory to a downstream payer
\n"], ["eT", "
TRICARE-NON BILLABLE
\n"], ["MY", "
M/I Address Count
\n"], ["NA", "
M/I Address Qualifier
\n"], ["NB", "
M/I Client Name
\n"], ["NC", "
M/I Discontinue Date Qualifier
\n"], ["ND", "
M/I Discontinue Date
\n"], ["NF", "
M/I Easy Open Cap Indicator
\n"], ["NG", "
M/I Effective Date
\n"], ["53", "
Non-Matched Person Code
\n"], ["NH", "
M/I Expiration Date
\n"], ["NJ", "
M/I File Structure Type
\n"], ["NK", "
M/I Inactive Prescription Indicator
\n"], ["NM", "
M/I Label Directions
\n"], ["NW", "
M/I Most Recent Date Filled
\n"], ["NY", "
M/I Number Of Fills To-Date
\n"], ["PU", "
M/I Number Of Fills Remaining
\n"], ["P0", "
Non-zero Value Required for Vaccine Administration
\n"], ["RQ", "
M/I Original Dispensed Date
\n"], ["RR", "
M/I Patient ID Count
\n"], ["54", "
Non-Matched Product/Service ID Number
\n"], ["RW", "
M/I Prescribed Drug Description
\n"], ["RX", "
M/I Prescriber ID Count
\n"], ["RY", "
M/I Prescriber Specialty
\n"], ["RZ", "
M/I Prescriber Specialty Count
\n"], ["R0", "
Professional Serv Cd of 'MA' req'd for Vaccine Incentive Fee Submitted
\n"], ["S0", "
Accumulator Month Count Does Not Match Number of Repetitions
\n"], ["S1", "
M/I Accumulator Year
\n"], ["S2", "
M/I Transaction Identifier
\n"], ["S3", "
M/I Accumulated Patient True Out Of Pocket Amount
\n"], ["S4", "
M/I Accumulated Gross Covered Drug Cost Amount
\n"], ["55", "
Non-Matched Product Package Size
\n"], ["S5", "
M/I DateTime
\n"], ["S6", "
M/I Accumulator Month
\n"], ["S7", "
M/I Accumulator Month Count
\n"], ["S8", "
Non-Matched Transaction Identifier
\n"], ["S9", "
M/I Financial Information Reporting Transaction Header Segment
\n"], ["SA", "
M/I Quantity Dispensed To Date
\n"], ["SB", "
M/I Record Delimiter
\n"], ["SC", "
M/I Remaining Quantity
\n"], ["SD", "
M/I Sender Name
\n"], ["SJ", "
M/I Total Number Of Sending And Receiving Pharmacy Records
\n"], ["56", "
Non-Matched Prescriber ID
\n"], ["SK", "
M/I Transfer Flag
\n"], ["SM", "
M/I Transfer Type
\n"], ["SN", "
M/I Package Acquisition Cost
\n"], ["SP", "
M/I Unique Record Identifier
\n"], ["SQ", "
M/I Unique Record Identifier Qualifier
\n"], ["SW", "
Accum Patient True Out of Pocket must be equal to or greater than zero
\n"], ["TD", "
M/I Pharmacist Initials
\n"], ["TG", "
Address Count Does Not Match Number Of Repetitions
\n"], ["TH", "
Patient ID Count Does Not Match Number Of Repetitions
\n"], ["TJ", "
Prescriber ID Count Does Not Match Number Of Repetitions
\n"], ["57", "
Non-Matched PA/MC Number
\n"], ["TK", "
Prescriber Specialty Count Does Not Match Number Of Repetitions
\n"], ["TM", "
Telephone Number Count Does Not Match Number Of Repetitions
\n"], ["T0", "
Accumulator Month Count Exceeds Number of Occurrences Supported
\n"], ["T1", "
Request Financial Segment Required For Financial Information Reporting
\n"], ["T2", "
M/I Request Reference Segment
\n"], ["T3", "
Out of Order DateTime
\n"], ["T4", "
Duplicate DateTime
\n"], ["U0", "
M/I Sending Pharmacy ID
\n"], ["V0", "
M/I Telephone Number Count
\n"], ["W0", "
M/I Telephone Number Qualifier
\n"], ["58", "
Non-Matched Primary Prescriber
\n"], ["W5", "
M/I Bed
\n"], ["W6", "
M/I Facility Unit
\n"], ["W7", "
M/I Hours of Administration
\n"], ["W8", "
M/I Room
\n"], ["W9", "
Accum Gross Cov Drug Cost Amt Must Be Equal To Or Greater Than Zero
\n"], ["X1", "
Accumulated Patient True Out of Pocket exceeds maximum
\n"], ["X2", "
Accumulated Gross Covered Drug Cost exceeds maximum
\n"], ["X3", "
Out of order Accumulator Months
\n"], ["X4", "
Accumulator Year is not within ATBT timeframe
\n"], ["X5", "
M/I Financial Information Reporting Request Insurance Segment
\n"], ["59", "
Non-Matched Clinic ID
\n"], ["X6", "
M/I Request Financial Segment
\n"], ["X7", "
Financial Info Reporting Req Ins Seg Required For Financial Reporting
\n"], ["X8", "
Procedure Modifier Code Count Exceeds Number Of Occurrences Supported
\n"], ["X9", "
Diagnosis Code Count Exceeds Number Of Occurrences Supported
\n"], ["YA", "
Compound Ingredient Mod Code Cnt Exceeds Num Of Occurrences Supported
\n"], ["YB", "
Other Amt Claimed Submitted Count Exceeds Num Of Occurrences Supported
\n"], ["YC", "
Other Payer Reject Count Exceeds Number Of Occurrences Supported
\n"], ["YD", "
Other Payer-Patient Resp Amt Cnt Exceeds Num Of Occurrences Supported
\n"], ["YE", "
Submission Clarification Code Cnt Exceeds Num of Occurrences Supported
\n"], ["YF", "
Question Number/Letter Count Exceeds Number Of Occurrences Supported
\n"], ["06", "
M/I Group ID
\n"], ["60", "
Product/Service Not Covered For Patient Age
\n"], ["YG", "
Benefit Stage Count Exceeds Number Of Occurrences Supported
\n"], ["YH", "
Clinical Information Counter Exceeds Number of Occurrences Supported
\n"], ["YJ", "
Medicaid Agency Number Not Supported
\n"], ["201", "
Patient Segment is not used for this Transaction Code
\n"], ["202", "
Insurance Segment is not used for this Transaction Code
\n"], ["203", "
Claim Segment is not used for this Transaction Code
\n"], ["204", "
Pharmacy Provider Segment is not used for this Transaction Code
\n"], ["205", "
Prescriber Segment is not used for this Transaction Code
\n"], ["206", "
COB/Other Payments Segment is not used for this Transaction Code
\n"], ["207", "
Workers' Compensation Segment is not used for this Transaction Code
\n"], ["61", "
Product/Service Not Covered For Patient Gender
\n"], ["208", "
DUR/PPS Segment is not used for this Transaction Code
\n"], ["209", "
Pricing Segment is not used for this Transaction Code
\n"], ["210", "
Coupon Segment is not used for this Transaction Code
\n"], ["211", "
Compound Segment is not used for this Transaction Code
\n"], ["212", "
Prior Authorization Segment is not used for this Transaction Code
\n"], ["213", "
Clinical Segment is not used for this Transaction Code
\n"], ["214", "
Additional Documentation Segment is not used for this Transaction Code
\n"], ["215", "
Facility Segment is not used for this Transaction Code
\n"], ["216", "
Narrative Segment is not used for this Transaction Code
\n"], ["217", "
Purchaser Segment is not used for this Transaction Code
\n"], ["62", "
Patient/Card Holder ID Name Mismatch
\n"], ["218", "
Service Provider Segment is not used for this Transaction Code
\n"], ["219", "
Patient ID Qualifier is not used for this Transaction Code
\n"], ["220", "
Patient ID is not used for this Transaction Code
\n"], ["221", "
Date of Birth is not used for this Transaction Code
\n"], ["222", "
Patient Gender Code is not used for this Transaction Code
\n"], ["223", "
Patient First Name is not used for this Transaction Code
\n"], ["224", "
Patient Last Name is not used for this Transaction Code
\n"], ["225", "
Patient Street Address is not used for this Transaction Code
\n"], ["226", "
Patient City Address is not used for this Transaction Code
\n"], ["227", "
Patient State/Province Address is not used for this Transaction Code
\n"], ["63", "
Product/Service ID Not Covered For Institutionalized Patient
\n"], ["228", "
Patient ZIP/Postal Zone is not used for this Transaction Code
\n"], ["229", "
Patient Phone Number is not used for this Transaction Code
\n"], ["230", "
Place of Service is not used for this Transaction Code
\n"], ["231", "
Employer ID is not used for this Transaction Code
\n"], ["232", "
Smoker/Non-Smoker Code is not used for this Transaction Code
\n"], ["233", "
Pregnancy Indicator is not used for this Transaction Code
\n"], ["234", "
Patient E-Mail Address is not used for this Transaction Code
\n"], ["235", "
Patient Residence is not used for this Transaction Code
\n"], ["236", "
Patient ID Assoc State/Province Address not used for this Trans Code
\n"], ["237", "
Cardholder First Name is not used for this Transaction Code
\n"], ["64", "
Claim Submitted Does Not Match Prior Authorization
\n"], ["238", "
Cardholder Last Name is not used for this Transaction Code
\n"], ["239", "
Home Plan is not used for this Transaction Code
\n"], ["240", "
Plan ID is not used for this Transaction Code
\n"], ["241", "
Eligibility Clarification Code is not used for this Transaction Code
\n"], ["242", "
Group ID is not used for this Transaction Code
\n"], ["243", "
Person Code is not used for this Transaction Code
\n"], ["244", "
Patient Relationship Code is not used for this Transaction Code
\n"], ["245", "
Other Payer BIN Number is not used for this Transaction Code
\n"], ["246", "
Other Payer Processor Control Number is not used for this Trans Code
\n"], ["247", "
Other Payer Cardholder ID is not used for this Transaction Code
\n"], ["65", "
Patient Is Not Covered
\n"], ["248", "
Other Payer Group ID is not used for this Transaction Code
\n"], ["249", "
Medigap ID is not used for this Transaction Code
\n"], ["250", "
Medicaid Indicator is not used for this Transaction Code
\n"], ["251", "
Provider Accept Assignment Indicator is not used for this Trans Code
\n"], ["252", "
CMS Part D Defined Qualified Facility is not used for this Trans Code
\n"], ["253", "
Medicaid ID Number is not used for this Transaction Code
\n"], ["254", "
Medicaid Agency Number is not used for this Transaction Code
\n"], ["255", "
Associated Rx/Service Reference Number is not used for this Trans Code
\n"], ["256", "
Associated Prescription/Service Date is not used for this Trans Code
\n"], ["257", "
Procedure Modifier Code Count is not used for this Transaction Code
\n"], ["66", "
Patient Age Exceeds Maximum Age
\n"], ["258", "
Procedure Modifier Code is not used for this Transaction Code
\n"], ["259", "
Quantity Dispensed is not used for this Transaction Code
\n"], ["260", "
Fill Number is not used for this Transaction Code
\n"], ["261", "
Days Supply is not used for this Transaction Code
\n"], ["262", "
Compound Code is not used for this Transaction Code
\n"], ["263", "
DAW/Product Selection Code is not used for this Trans Code
\n"], ["264", "
Date Prescription Written is not used for this Transaction Code
\n"], ["265", "
Number of Refills Authorized is not used for this Transaction Code
\n"], ["266", "
Prescription Origin Code is not used for this Transaction Code
\n"], ["267", "
Submission Clarification Code Count is not used for this Trans Code
\n"], ["67", "
Filled Before Coverage Effective
\n"], ["268", "
Submission Clarification Code is not used for this Transaction Code
\n"], ["269", "
Quantity Prescribed is not used for this Transaction Code
\n"], ["270", "
Other Coverage Code is not used for this Transaction Code
\n"], ["271", "
Special Packaging Indicator is not used for this Transaction Code
\n"], ["272", "
Originally Prescribed Prod/Serv ID Qual not used for this Trans Code
\n"], ["273", "
Originally Prescribed Prod/Serv Code is not used for this Trans Code
\n"], ["274", "
Originally Prescribed Quantity is not used for this Transaction Code
\n"], ["275", "
Alternate ID is not used for this Transaction Code
\n"], ["276", "
Scheduled Prescription ID Number is not used for this Transaction Code
\n"], ["277", "
Unit of Measure is not used for this Transaction Code
\n"], ["68", "
Filled After Coverage Expired
\n"], ["278", "
Level of Service is not used for this Transaction Code
\n"], ["279", "
Prior Authorization Type Code is not used for this Transaction Code
\n"], ["280", "
Prior Authorization ID Submitted is not used for this Transaction Code
\n"], ["281", "
Intermediary Authorization Type ID is not used for this Trans Code
\n"], ["282", "
Intermediary Authorization ID is not used for this Transaction Code
\n"], ["283", "
Dispensing Status is not used for this Transaction Code
\n"], ["284", "
Quantity Intended to be Dispensed is not used for this Trans Code
\n"], ["285", "
Days Supply Intended to be Dispensed is not used for this Trans Code
\n"], ["286", "
Delay Reason Code is not used for this Transaction Code
\n"], ["287", "
Transaction Reference Number is not used for this Transaction Code
\n"], ["69", "
Filled After Coverage Terminated
\n"], ["288", "
Patient Assignment Indicator is not used for this Trans Code
\n"], ["289", "
Route of Administration is not used for this Transaction Code
\n"], ["290", "
Compound Type is not used for this Transaction Code
\n"], ["291", "
Medicaid Subrogation ICN/TCN is not used for this Transaction Code
\n"], ["292", "
Pharmacy Service Type is not used for this Transaction Code
\n"], ["293", "
Associated Rx/Service Provider ID Qual is not used for this Trans Code
\n"], ["294", "
Associated Rx/Service Provider ID is not used for this Trans Code
\n"], ["295", "
Associated Rx/Service Ref Num Qual is not used for this Trans Code
\n"], ["296", "
Associated Rx/Service Ref Fill Number is not used for this Trans Code
\n"], ["297", "
Time of Service is not used for this Transaction Code
\n"], ["07", "
M/I Cardholder ID
\n"], ["70", "
Product/Service Not Covered - Plan/Benefit Exclusion
\n"], ["298", "
Sales Transaction ID is not used for this Transaction Code
\n"], ["299", "
Reported Adjudicated Program Type Is Not Used For This Transaction Code
\n"], ["300", "
Provider ID Qualifier is not used for this Transaction Code
\n"], ["301", "
Provider ID is not used for this Transaction Code
\n"], ["302", "
Prescriber ID Qualifier is not used for this Transaction Code
\n"], ["303", "
Prescriber ID is not used for this Transaction Code
\n"], ["304", "
Prescriber ID Assoc State/Prov Address not used for this Trans Code
\n"], ["305", "
Prescriber Last Name is not used for this Transaction Code
\n"], ["306", "
Prescriber Phone Number is not used for this Transaction Code
\n"], ["307", "
Primary Care Provider ID Qualifier is not used for this Trans Code
\n"], ["71", "
Prescriber ID Is Not Covered
\n"], ["308", "
Primary Care Provider ID is not used for this Transaction Code
\n"], ["309", "
Primary Care Provider Last Name is not used for this Transaction Code
\n"], ["310", "
Prescriber First Name is not used for this Transaction Code
\n"], ["311", "
Prescriber Street Address is not used for this Transaction Code
\n"], ["312", "
Prescriber City Address is not used for this Transaction Code
\n"], ["313", "
Prescriber State/Province Address is not used for this Trans Code
\n"], ["314", "
Prescriber ZIP/Postal Zone is not used for this Transaction Code
\n"], ["315", "
Prescriber Alternate ID Qualifier is not used for this Trans Code
\n"], ["316", "
Prescriber Alternate ID is not used for this Transaction Code
\n"], ["317", "
Prescriber Alt ID Assoc State/Prov Address not used for this Trans Cd
\n"], ["72", "
Primary Prescriber Is Not Covered
\n"], ["318", "
Other Payer ID Qualifier is not used for this Transaction Code
\n"], ["319", "
Other Payer ID is not used for this Transaction Code
\n"], ["320", "
Other Payer Date is not used for this Transaction Code
\n"], ["321", "
Internal Control Number is not used for this Transaction Code
\n"], ["322", "
Other Payer Amount Paid Count is not used for this Transaction Code
\n"], ["323", "
Other Payer Amount Paid Qualifier is not used for this Trans Code
\n"], ["324", "
Other Payer Amount Paid is not used for this Transaction Code
\n"], ["325", "
Other Payer Reject Count is not used for this Transaction Code
\n"], ["326", "
Other Payer Reject Code is not used for this Transaction Code
\n"], ["327", "
Other Payer-Patient Resp Amount Count is not used for this Trans Code
\n"], ["73", "
Refills Are Not Covered
\n"], ["328", "
Other Payer-Patient Resp Amount Qual is not used for this Trans Code
\n"], ["329", "
Other Payer-Patient Resp Amount is not used for this Trans Code
\n"], ["330", "
Benefit Stage Count is not used for this Transaction Code
\n"], ["331", "
Benefit Stage Qualifier is not used for this Transaction Code
\n"], ["332", "
Benefit Stage Amount is not used for this Transaction Code
\n"], ["333", "
Employer Name is not used for this Transaction Code
\n"], ["334", "
Employer Street Address is not used for this Transaction Code
\n"], ["335", "
Employer City Address is not used for this Transaction Code
\n"], ["336", "
Employer State/Province Address is not used for this Transaction Code
\n"], ["337", "
Employer Zip/Postal Code is not used for this Transaction Code
\n"], ["74", "
Other Carrier Payment Meets Or Exceeds Payable
\n"], ["338", "
Employer Phone Number is not used for this Transaction Code
\n"], ["339", "
Employer Contact Name is not used for this Transaction Code
\n"], ["340", "
Carrier ID is not used for this Transaction Code
\n"], ["341", "
Claim/Reference ID is not used for this Transaction Code
\n"], ["342", "
Billing Entity Type Indicator is not used for this Transaction Code
\n"], ["343", "
Pay To Qualifier is not used for this Transaction Code
\n"], ["344", "
Pay To ID is not used for this Transaction Code
\n"], ["345", "
Pay To Name is not used for this Transaction Code
\n"], ["346", "
Pay To Street Address is not used for this Transaction Code
\n"], ["347", "
Pay To City Address is not used for this Transaction Code
\n"], ["75", "
Prior Authorization Required
\n"], ["348", "
Pay To State/Province Address is not used for this Transaction Code
\n"], ["349", "
Pay To ZIP/Postal Zone is not used for this Transaction Code
\n"], ["350", "
Generic Equivalent Product ID Qual is not used for this Trans Code
\n"], ["351", "
Generic Equivalent Product ID is not used for this Transaction Code
\n"], ["352", "
DUR/PPS Code Counter is not used for this Transaction Code
\n"], ["353", "
Reason for Service Code is not used for this Transaction Code
\n"], ["354", "
Professional Service Code is not used for this Transaction Code
\n"], ["355", "
Result of Service Code is not used for this Transaction Code
\n"], ["356", "
DUR/PPS Level of Effort is not used for this Transaction Code
\n"], ["357", "
DUR Co-Agent ID Qualifier is not used for this Transaction Code
\n"], ["76", "
Plan Limitations Exceeded
\n"], ["358", "
DUR Co-Agent ID is not used for this Transaction Code
\n"], ["359", "
Ingredient Cost Submitted is not used for this Transaction Code
\n"], ["360", "
Dispensing Fee Submitted is not used for this Transaction Code
\n"], ["361", "
Professional Service Fee Submitted is not used for this Trans Code
\n"], ["362", "
Patient Pay Amount Reported is not used for this Transaction Code
\n"], ["363", "
Incentive Amount Submitted is not used for this Transaction Code
\n"], ["364", "
Other Amount Claimed Submitted Count is not used for this Trans Code
\n"], ["365", "
Other Amount Claimed Submitted Qual is not used for this Trans Code
\n"], ["366", "
Other Amount Claimed Submitted is not used for this Transaction Code
\n"], ["367", "
Regulatory Fee Amount Submitted Is Not Used For This Transaction Code
\n"], ["77", "
Discontinued Product/Service ID Number
\n"], ["368", "
Percentage Sales Tax Amount Submitted is not used for this Trans Code
\n"], ["369", "
Percentage Sales Tax Rate Submitted is not used for this Trans Code
\n"], ["370", "
Percentage Sales Tax Basis Submitted is not used for this Trans Code
\n"], ["371", "
Usual and Customary Charge is not used for this Transaction Code
\n"], ["372", "
Gross Amount Due is not used for this Transaction Code
\n"], ["373", "
Basis of Cost Determination is not used for this Transaction Code
\n"], ["374", "
Medicaid Paid Amount is not used for this Transaction Code
\n"], ["375", "
Coupon Value Amount is not used for this Transaction Code
\n"], ["376", "
Compound Ingredient Drug Cost is not used for this Transaction Code
\n"], ["377", "
Compound Ingredient Basis of Cost Determ not used for this Trans Code
\n"], ["78", "
Cost Exceeds Maximum
\n"], ["378", "
Compound Ingredient Modifier Code Count not used for this Trans Code
\n"], ["379", "
Compound Ingredient Modifier Code is not used for this Trans Code
\n"], ["380", "
Authorized Representative First Name is not used for this Trans Code
\n"], ["381", "
Authorized Rep. Last Name is not used for this Transaction Code
\n"], ["382", "
Authorized Rep. Street Address is not used for this Transaction Code
\n"], ["383", "
Authorized Rep. City is not used for this Transaction Code
\n"], ["384", "
Authorized Rep. State/Province is not used for this Transaction Code
\n"], ["385", "
Authorized Rep. Zip/Postal Code is not used for this Transaction Code
\n"], ["386", "
Prior Authorization Number - Assigned is not used for this Trans Code
\n"], ["387", "
Authorization Number is not used for this Transaction Code
\n"], ["79", "
Refill Too Soon
\n"], ["388", "
Prior Auth Supporting Documentation is not used for this Trans Code
\n"], ["389", "
Diagnosis Code Count is not used for this Transaction Code
\n"], ["390", "
Diagnosis Code Qualifier is not used for this Transaction Code
\n"], ["391", "
Diagnosis Code is not used for this Transaction Code
\n"], ["392", "
Clinical Information Counter is not used for this Transaction Code
\n"], ["393", "
Measurement Date is not used for this Transaction Code
\n"], ["394", "
Measurement Time is not used for this Transaction Code
\n"], ["395", "
Measurement Dimension is not used for this Transaction Code
\n"], ["396", "
Measurement Unit is not used for this Transaction Code
\n"], ["397", "
Measurement Value is not used for this Transaction Code
\n"], ["08", "
M/I Person Code
\n"], ["80", "
Drug-Diagnosis Mismatch
\n"], ["398", "
Request Period Begin Date is not used for this Transaction Code
\n"], ["399", "
Request Period Recert/Revised Date is not used for this Trans Code
\n"], ["400", "
Request Status is not used for this Transaction Code
\n"], ["401", "
Length Of Need Qualifier is not used for this Transaction Code
\n"], ["402", "
Length Of Need is not used for this Transaction Code
\n"], ["403", "
Prescriber/Supplier Date Signed is not used for this Transaction Code
\n"], ["404", "
Supporting Documentation is not used for this Transaction Code
\n"], ["405", "
Question Number/Letter Count is not used for this Transaction Code
\n"], ["406", "
Question Number/Letter is not used for this Transaction Code
\n"], ["407", "
Question Percent Response is not used for this Transaction Code
\n"], ["81", "
Claim Too Old
\n"], ["408", "
Question Date Response is not used for this Transaction Code
\n"], ["409", "
Question Dollar Amount Response is not used for this Transaction Code
\n"], ["410", "
Question Numeric Response is not used for this Transaction Code
\n"], ["411", "
Question Alphanumeric Response is not used for this Transaction Code
\n"], ["412", "
Facility ID is not used for this Transaction Code
\n"], ["413", "
Facility Name is not used for this Transaction Code
\n"], ["414", "
Facility Street Address is not used for this Transaction Code
\n"], ["415", "
Facility City Address is not used for this Transaction Code
\n"], ["416", "
Facility State/Province Address is not used for this Transaction Code
\n"], ["417", "
Facility ZIP/Postal Zone is not used for this Transaction Code
\n"], ["82", "
Claim Is Post-Dated
\n"], ["418", "
Purchaser ID Qualifier is not used for this Transaction Code
\n"], ["419", "
Purchaser ID is not used for this Transaction Code
\n"], ["420", "
Purchaser ID Associated State Code is not used for this Trans Code
\n"], ["421", "
Purchaser Date of Birth is not used for this Transaction Code
\n"], ["422", "
Purchaser Gender Code is not used for this Transaction Code
\n"], ["423", "
Purchaser First Name is not used for this Transaction Code
\n"], ["424", "
Purchaser Last Name is not used for this Transaction Code
\n"], ["425", "
Purchaser Street Address is not used for this Transaction Code
\n"], ["426", "
Purchaser City Address is not used for this Transaction Code
\n"], ["427", "
Purchaser State/Province Address is not used for this Transaction Code
\n"], ["83", "
Duplicate Paid/Captured Claim
\n"], ["428", "
Purchaser ZIP/Postal Zone is not used for this Transaction Code
\n"], ["429", "
Purchaser Country Code is not used for this Transaction Code
\n"], ["430", "
Purchaser Relationship Code is not used for this Transaction Code
\n"], ["431", "
Released Date is not used for this Transaction Code
\n"], ["432", "
Released Time is not used for this Transaction Code
\n"], ["433", "
Service Provider Name is not used for this Transaction Code
\n"], ["434", "
Service Provider Street Address is not used for this Transaction Code
\n"], ["435", "
Service Provider City Address is not used for this Transaction Code
\n"], ["436", "
Service Prov State/Province Address is not used for this Trans Code
\n"], ["437", "
Service Provider ZIP/Postal Zone is not used for this Transaction Code
\n"], ["84", "
Claim Has Not Been Paid/Captured
\n"], ["438", "
Seller ID Qualifier is not used for this Transaction Code
\n"], ["439", "
Seller ID is not used for this Transaction Code
\n"], ["440", "
Seller Initials is not used for this Transaction Code
\n"], ["441", "
Other Amount Claimed Submitted Grouping Incorrect
\n"], ["442", "
Other Payer Amount Paid Grouping Incorrect
\n"], ["443", "
Other Payer-Patient Responsibility Amount Grouping Incorrect
\n"], ["444", "
Benefit Stage Amount Grouping Incorrect
\n"], ["445", "
Diagnosis Code Grouping Incorrect
\n"], ["446", "
COB/Other Payments Segment Incorrectly Formatted
\n"], ["447", "
Additional Documentation Segment Incorrectly Formatted
\n"], ["85", "
Claim Not Processed
\n"], ["448", "
Clinical Segment Incorrectly Formatted
\n"], ["449", "
Patient Segment Incorrectly Formatted
\n"], ["450", "
Insurance Segment Incorrectly Formatted
\n"], ["451", "
Transaction Header Segment Incorrectly Formatted
\n"], ["452", "
Claim Segment Incorrectly Formatted
\n"], ["453", "
Pharmacy Provider Segment Incorrectly Formatted
\n"], ["454", "
Prescriber Segment Incorrectly Formatted
\n"], ["455", "
Workers' Compensation Segment Incorrectly Formatted
\n"], ["456", "
Pricing Segment Incorrectly Formatted
\n"], ["457", "
Coupon Segment Incorrectly Formatted
\n"], ["86", "
Submit Manual Reversal
\n"], ["458", "
Prior Authorization Segment Incorrectly Formatted
\n"], ["459", "
Facility Segment Incorrectly Formatted
\n"], ["460", "
Narrative Segment Incorrectly Formatted
\n"], ["461", "
Purchaser Segment Incorrectly Formatted
\n"], ["462", "
Service Provider Segment Incorrectly Formatted
\n"], ["463", "
Pharmacy not contracted in Assisted Living Network
\n"], ["464", "
Service Provider ID Qualifier Does Not Precede Service Provider ID
\n"], ["465", "
Patient ID Qualifier Does Not Precede Patient ID
\n"], ["466", "
Rx/Service Ref Number Qualifier Does Not Precede Rx/Service Ref Number
\n"], ["467", "
Product/Service ID Qualifier Does Not Precede Product/Service ID
\n"], ["87", "
Reversal Not Processed
\n"], ["468", "
Procedure Modifier Code Count Does Not Precede Procedure Modifier Code
\n"], ["469", "
Submission Clarification Cd Cnt Follows Submission Clarification Code
\n"], ["470", "
Orig Prscrbd Prod/Serv ID Qual Follows Orig Prscrbd Prod/Serv Code
\n"], ["471", "
Oth Amt Claimed Submitted Cnt Follows Oth Amt Claimed Amt And/Or Qual
\n"], ["472", "
Other Amt Claimed Submitted Qual Follows Other Amt Claimed Submitted
\n"], ["473", "
Provider Id Qualifier Does Not Precede Provider ID
\n"], ["474", "
Prescriber Id Qualifier Does Not Precede Prescriber ID
\n"], ["475", "
Primary Care Prov ID Qual Does Not Precede Primary Care Provider ID
\n"], ["476", "
COB/Other Payments Count Does Not Precede Other Payer Coverage Type
\n"], ["477", "
Other Payer ID Count Does Not Precede Other Payer ID Data Fields
\n"], ["88", "
DUR Reject Error
\n"], ["478", "
Other Payer ID Qualifier Does Not Precede Other Payer ID
\n"], ["479", "
Other Payer Amt Paid Count Follows Other Payer Amt Paid And/Or Qual
\n"], ["480", "
Other Payer Amount Paid Qual Does Not Precede Other Payer Amount Paid
\n"], ["481", "
Other Payer Reject Count Does Not Precede Other Payer Reject Code
\n"], ["482", "
Oth Payer-Pat Resp Amt Cnt Follows Oth Payer-Pat Resp Amt and/or Qual
\n"], ["483", "
Other Payer-Patient Resp Amt Qual Follows Other Payer-Patient Resp Amt
\n"], ["484", "
Benefit Stage Count Does Not Precede Benefit Stage Amount and/or Qual
\n"], ["485", "
Benefit Stage Qualifier Does Not Precede Benefit Stage Amount
\n"], ["486", "
Pay To Qualifier Does Not Precede Pay To ID
\n"], ["487", "
Generic Equivalent Prod Id Qual Follows Generic Equivalent Prod Id
\n"], ["89", "
Rejected Claim Fees Paid
\n"], ["488", "
DUR/PPS Code Counter Does Not Precede DUR Data Fields
\n"], ["489", "
DUR Co-Agent ID Qualifier Does Not Precede DUR Co-Agent ID
\n"], ["490", "
Compound Ingredient Component Cnt Follows Compound Prod ID And/Or Qual
\n"], ["491", "
Compound Product ID Qualifier Does Not Precede Compound Product ID
\n"], ["492", "
Compound Ingredient Mod Code Cnt Follows Compound Ingredient Mod Code
\n"], ["493", "
Diagnosis Code Count Does Not Precede Diagnosis Code And/Or Qualifier
\n"], ["494", "
Diagnosis Code Qualifier Does Not Precede Diagnosis Code
\n"], ["495", "
Clinical Info Counter Does Not Precede Clinical Measurement data
\n"], ["496", "
Length Of Need Qualifier Does Not Precede Length Of Need
\n"], ["497", "
Question Number/Letter Count Does Not Precede Question Number/Letter
\n"], ["09", "
M/I Date Of Birth
\n"], ["90", "
Host Hung Up
\n"], ["498", "
Accumulator Month Count Does Not Precede Accumulator Month
\n"], ["499", "
Address Count Does Not Precede Address Data Fields
\n"], ["500", "
Patient ID Count Does Not Precede Patient ID Data Fields
\n"], ["501", "
Prescriber ID Count Does Not Precede Prescriber ID Data Fields
\n"], ["502", "
Prescriber Specialty Count Does Not Precede Prescriber Specialty
\n"], ["503", "
Telephone Number Count Does Not Precede Telephone Number Data Fields
\n"], ["504", "
Benefit Stage Qualifier Value Not Supported
\n"], ["505", "
Other Payer Coverage Type Value Not Supported
\n"], ["506", "
Prescription/Service Reference Number Qualifier Value Not Supported
\n"], ["507", "
Additional Documentation Type ID Value Not Supported
\n"], ["91", "
Host Response Error
\n"], ["508", "
Authorized Representative State/Province Address Value Not Supported
\n"], ["509", "
Basis Of Request Value Not Supported
\n"], ["510", "
Billing Entity Type Indicator Value Not Supported
\n"], ["511", "
CMS Part D Defined Qualified Facility Value Not Supported
\n"], ["512", "
Compound Code Value Not Supported
\n"], ["513", "
Compound Dispensing Unit Form Indicator Value Not Supported
\n"], ["514", "
Compound Ingredient Basis of Cost Determination Value Not Supported
\n"], ["515", "
Compound Product ID Qualifier Value Not Supported
\n"], ["516", "
Compound Type Value Not Supported
\n"], ["517", "
Coupon Type Value Not Supported
\n"], ["92", "
System Unavailable/Host Unavailable
\n"], ["518", "
DUR Co-Agent ID Qualifier Value Not Supported
\n"], ["519", "
DUR/PPS Level Of Effort Value Not Supported
\n"], ["520", "
Delay Reason Code Value Not Supported
\n"], ["521", "
Diagnosis Code Qualifier Value Not Supported
\n"], ["522", "
Dispensing Status Value Not Supported
\n"], ["523", "
Eligibility Clarification Code Value Not Supported
\n"], ["524", "
Employer State/Province Address Value Not Supported
\n"], ["525", "
Facility State/Province Address Value Not Supported
\n"], ["526", "
Header Response Status Value Not Supported
\n"], ["527", "
Intermediary Authorization Type ID Value Not Supported
\n"], ["93", "
Planned Unavailable
\n"], ["528", "
Length of Need Qualifier Value Not Supported
\n"], ["529", "
Level Of Service Value Not Supported
\n"], ["530", "
Measurement Dimension Value Not Supported
\n"], ["531", "
Measurement Unit Value Not Supported
\n"], ["532", "
Medicaid Indicator Value Not Supported
\n"], ["533", "
Originally Prescribed Product/Service ID Qualifier Value Not Supported
\n"], ["534", "
Other Amount Claimed Submitted Qualifier Value Not Supported
\n"], ["535", "
Other Coverage Code Value Not Supported
\n"], ["536", "
Other Payer-Patient Responsibility Amount Qual Value Not Supported
\n"], ["537", "
Patient Assignment Indicator Value Not Supported
\n"], ["94", "
Invalid Message
\n"], ["538", "
Patient Gender Code Value Not Supported
\n"], ["539", "
Patient State/Province Address Value Not Supported
\n"], ["540", "
Pay to State/Province Address Value Not Supported
\n"], ["541", "
Percentage Sales Tax Basis Submitted Value Not Supported
\n"], ["542", "
Pregnancy Indicator Value Not Supported
\n"], ["543", "
Prescriber ID Qualifier Value Not Supported
\n"], ["544", "
Prescriber State/Province Address Value Not Supported
\n"], ["545", "
Prescription Origin Code Value Not Supported
\n"], ["546", "
Primary Care Provider ID Qualifier Value Not Supported
\n"], ["547", "
Prior Authorization Type Code Value Not Supported
\n"], ["95", "
Time Out
\n"], ["548", "
Provider Accept Assignment Indicator Value Not Supported
\n"], ["549", "
Provider ID Qualifier Value Not Supported
\n"], ["550", "
Request Status Value Not Supported
\n"], ["551", "
Request Type Value Not Supported
\n"], ["552", "
Route of Administration Value Not Supported
\n"], ["553", "
Smoker/Non-Smoker Code Value Not Supported
\n"], ["554", "
Special Packaging Indicator Value Not Supported
\n"], ["555", "
Transaction Count Value Not Supported
\n"], ["556", "
Unit Of Measure Value Not Supported
\n"], ["557", "
COB Segment Present On A Non-COB Claim
\n"], ["96", "
Scheduled Downtime
\n"], ["7F", "
Future date not allowed for Date of Birth
\n"], ["A1", "
ID Submitted Is Associated With An Excluded Prescriber
\n"], ["A2", "
ID Submitted is associated to a Deceased Prescriber
\n"], ["TF", "
M/I Technician Initials
\n"], ["X0", "
M/I Associated Prescription/Service Fill Number
\n"], ["XZ", "
M/I Associated Prescription/Service Reference Number Qualifier
\n"], ["Y0", "
M/I Purchaser Last Name
\n"], ["Y1", "
M/I Purchaser Street Address
\n"], ["Y2", "
M/I Purchaser City Address
\n"], ["Y3", "
M/I Purchaser State/Province Code
\n"], ["97", "
Payer Unavailable
\n"], ["Y4", "
M/I Purchaser Zip/Postal Code
\n"], ["Y5", "
M/I Purchaser Country Code
\n"], ["Y6", "
M/I Time of Service
\n"], ["Y7", "
M/I Associated Prescription/Service Provider ID Qualifier
\n"], ["Y8", "
M/I Associated Prescription/Service Provider ID
\n"], ["Y9", "
M/I Seller ID
\n"], ["YK", "
M/I Service Provider Name
\n"], ["YM", "
M/I Service Provider Street Address
\n"], ["YN", "
M/I Service Provider City Address
\n"], ["YP", "
M/I Service Provider State/Province Code Address
\n"], ["98", "
Connection To Payer Is Down
\n"], ["YQ", "
M/I Service Provider Zip/Postal Code
\n"], ["YR", "
M/I Patient ID Associated State/Province Address
\n"], ["YS", "
M/I Purchaser Relationship Code
\n"], ["YT", "
M/I Seller Initials
\n"], ["YU", "
M/I Purchaser ID Qualifier
\n"], ["YV", "
M/I Purchaser ID
\n"], ["YW", "
M/I Purchaser ID Associated State/Province Code
\n"], ["YX", "
M/I Purchaser Date of Birth
\n"], ["YY", "
M/I Purchaser Gender Code
\n"], ["YZ", "
M/I Purchaser First Name
\n"], ["99", "
Host Processing Error
\n"], ["Z0", "
Purchaser Country Code Value Not Supported For Processor/Payer
\n"], ["Z1", "
Prescriber Alternate ID Qualifier Value Not Supported
\n"], ["Z2", "
M/I Purchaser Segment
\n"], ["Z3", "
Purchaser Segment Present On A Non-Controlled Sub Reporting Trans
\n"], ["Z4", "
Purchaser Segment Required On A Controlled Substance Reporting Trans
\n"], ["Z5", "
M/I Service Provider Segment
\n"], ["Z6", "
Service Prov Segment Present On A non-Controlled Sub Reporting Trans
\n"], ["Z7", "
Service Provider Segment Required On A Controlled Sub Reporting Trans
\n"], ["Z8", "
Purchaser Relationship Code Value Not Supported
\n"], ["Z9", "
Prescriber Alternate ID Not Covered
\n"]]}