SOFTWARE GROUP
Collection From Cardholder Not Allowed
Read 546 times
- On the rx remove the number(s) from Pat. Pay field
Published in Rejections
M-I Diagnosis Code
Read 896 times
- On the prescription screen verfiy there is a valid ICD-9 code (Insurance company have to give you the code)
Published in Rejections
M/I Prescription Origin Code
Read 320 times
- On the prescription screen select the Origin CD for which the prescription originated.
Published in Rejections
- OK CHECK QTY BEING BILLED AND CHECK THE QTY IN THE COMPOUND DRUG MUST MATCH. (or change dispensing fee? BWS)
Published in Rejections
M-I Claim Segment
Read 521 times
- Missing ICD9 code to TAR
Published in Rejections
M/I Authorization Number
Read 851 times
- Medi-cal Only: The information billed does not match the information on the TAR. Verify all information. Resubmit the corrected claim, if necessary. If necessary, ask the field office to modify the TAR.
Published in Rejections
Date Of Service Prior To Date Of Birth
Read 456 times
- Make sure Rx Date is not before the patients date of birth. Date of birt on patient pofile screen (F2) General tab.
Published in Rejections
M-I COMPOUND TYPE
Read 452 times
- M-I means Missing or Invalid 1) Go to UTILITIES RX OVERRIDE CODES COMPOUND TYPE 01 - Anti-infective 02 - Ionotropic 03 - Chemotherapy 04 - Pain management 05 - TPN-PPN (Hepatic Renal Pediatric) Total Parenteral Nutrition-Peripheral Parenteral Nutrition 06 - Hydration 07 - Ophthalmic 99 - Other
Published in Rejections
M/I Submission Clarification Code
Read 472 times
- On the prescription screen select the Clarification Code if needed.
- TIP: Medi-Cal Code 1 Restriction must use Clarification Code 7= Medically Necessary. If use it is reuire to noted it on the prescription hard copy.
Published in Rejections
QMB (Qualified Medicare Beneficiary)-Bill Medicare
Read 245 times
- Must bill to Medicare plan. You can check ELIGIBILITY for Medicare D members.
Published in Rejections
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Claim Not Processed
Read 415 times
- Insurance system is down
Published in Rejections
Host Processing Error
Read 245 times
- Insurance company is down.
Published in Rejections
- In the TAR field enter the prior authorization code of 5 and the chemo start date (2 digit year) Example "5112513" for November 25 2013.
Published in Rejections
Reversal Not Processed
Read 641 times
- If submitting a reversal verify that the information on the reversal is the same as the number on the original claim. Verify that you have not already reversed this claim. Resubmit the corrected reversal if necessary.
