SOFTWARE GROUP
Product-Service Not Covered For Patient Gender
Read 546 times
- Verify the recipient's gender. Resubmit the corrected claim if necessary. For compound pharmacy claims verify ingredient product ID for indicated occurrence.
Published in Rejections
Patient Is Not Covered
Read 896 times
- Verify the recipient ID number billed and resubmit the corrected claim. If necessary submit an eligibility verification transaction to determine if the recipient is eligible on the date of service.
Published in Rejections
Plan Limitations Exceeded
Read 320 times
- Verify the recipient ID and-or date of service. The recipient has exceeded the prescription limit for the calendar month. The claim requires an approved TAR. For compound pharmacy claims verify ingredient product ID for indicated occurrence. The six prescription per month limit applies to compound claims electronically billed. When the denial code is 009 the ingredient is not payable even with a TAR. You may use a “Y” in the Process for Approved Ingredients indicator to indicate acceptance of a payment of zero for ingredients with this error when the denial code is 009.
Published in Rejections
Non-Matched Primary Prescriber
Read 596 times
- Verify the Primary Care name in the Patient Profile Screen F2 is correct in the PCP field.
Published in Rejections
M-I Date Prescription Written
Read 521 times
- Verify the prescription Date Written. Go to EXTRAS scroll down to RX Date Written CTRL +O.
Published in Rejections
Date Written Is After Date Filled
Read 851 times
- Verify the prescription Date is not greater that Rx Date Written. To change Rx Date Written go to EXTRAS then scroll down to RX DATE WRITTEN CTRL+O.
Published in Rejections
Non-Matched Person Code
Read 456 times
- Verify the patient plan information (F8) has the correct person code 01 - Self 02-Spouse 03-Child 04-Other
Published in Rejections
Patient-Card Holder ID Name Mismatch
Read 452 times
- Verify the name of the actual Card Holder appears in the Patient Plan Screen F8 in the Card Holder Name field.
Published in Rejections
Billing Provider Not Eligible To Bill This Claim Type
Read 472 times
- Verify the provider number date of service and-or drug code. Resubmit the corrected claim if necessary. If you receive the denial again your provider number may not be listed correctly on the Provider Master File.
Published in Rejections
M/I Number Refills Authorized.
Read 245 times
- Verify the prescription has the exact number of refills approved by insurance company.
Published in Rejections
More...
Requires Manual Claim.
Read 415 times
- Verify the information entered. Resubmit corrected claim if necessary. Otherwise submit a Computer Media Claims (CMC) for non-compounds or hard copy claim. For compound pharmacy claims verify ingredient product ID and ingredient product ID qualifier for indicated occurrence. If the ingredient product ID is not an NDC it must be billed on hard copy claim 30-4. Medi-Cal will not pay for medical supplies used to prepare a compound when submitted on the compound claim either electronically or on paper. You may use a “Y” in the Process for Approved Ingredients indicator to indicate acceptance of a payment of zero for ingredients with this error.
Published in Rejections
Days Supply Limitation For Product-Service
Read 245 times
- Verify the estimated days supply billed. Resubmit the corrected claim if necessary. One hundred days supply is the maximum for most drugs.
Published in Rejections
Non-Matched Product Package Size
Read 252 times
- Verify the Drug Package Size in the Drug Record screen F4.
Published in Rejections
Patient Age Exceeds Maximum Age
Read 641 times
- Verify the date of birth and resubmit the corrected claim. If billing for a newborn with the mother’s ID you may need to hard copy bill the claim. For compound pharmacy claims verify ingredient product ID for indicated occurrence.
