CODES FOR PHARMACY ONLINE CLAIMS PROCESSING

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1 S FOR PHARMACY ONLINE CLAIMS PROCESSING The following is a list of error and warning codes that may appear when processing claims on the online system. The error codes are bolded. CODE AA AB AI AR CB CD CE CF CG CH CI CJ CK CN CM CO CP CR CS CT EC ED EF FC GA GB GC GE HSN not on file Registry Number (DIAND) not on file First Nations/Inuit beneficiary not covered by the Drug Plan HSN does not have current valid coverage Prescriber ineligible on dispensing date Prescriber inactive (dispensing date within 365 days of expiry date) Prescriber not on file Prescriber inactive (dispensing date greater than 365 days from expiry date) Prescriber suspended or revoked on dispensing date Invalid Pharmacist Organization ID Pharmacist not on file Pharmacist ineligible on dispensing date Invalid Health Provider Organization ID Pharmacist ineligible to prescribe this medication Prescriber not eligible for methadone DIN claimed Pharmacy not on file Pharmacy inactive (no contract for dispensing date) Dispensing date is more than 62 days in the past Dispensing date invalid Invalid prescription number ECP fee not allowed as EC prescription not found Duplicate submission of ECP fee Maximum ECP fee exceeded Limited time for formulary clearance Benefit Rxs - possible duplicate (same pharmacy/same Benefit Rxs - possible duplicate (same pharmacy/different recommended quantity exceeded Formulary/EDS drug - maximum allowable unit drug cost exceeded 278

2 GG GH GI GJ GK GL GM GN Non-formulary drug - maximum allowable unit drug cost exceeded - check unit drug cost Non-formulary drug - maximum allowable unit drug cost exceeded Dispense SOC for payment recommended quantity exceeded & possible duplicate Total prescription cost exceeded (communications unavailable) Patient paid exceeded (communications unavailable) Recommended quantity exceeded & possible duplicate possible duplicate GO Dispensing fee exceeds maximum allowable GP Benefit Rxs - possible duplicate (different pharmacy/same GQ Benefit Rxs - possible duplicate (different pharmacy/different GR Age inconsistent with drug GT Total prescription cost invalid (communications unavailable) GU Patient paid invalid (communications unavailable) GW Compound unit drug cost & compounding fee exceeds established amounts GX Compound quantity must be one (1) GY Compound unit drug cost exceeds established amount GZ Compounding fee exceeds established amount HA Non-benefit DIN HB DIN not on file HC Benefit Rxs - 3 submissions exceeded (same drug/same HD Benefit Rxs - 3 submissions exceeded (same drug/different pharmacies) HE Possible benefit under Exception Drug Status HF Palliative Care - 3 submissions exceeded (same drug/same HG Palliative Care - 3 submissions exceeded (same drug/different pharmacies) HH Palliative Care - 3 submissions exceeded (same drug & same/different pharmacies) & recommended quantity exceeded HI Palliative Care - 3 submissions exceeded (same drug & same/different pharmacies) & non-formulary maximum allowable unit drug cost exceeded 279

3 HJ IP IS IT KA KB KJ KM KN KP KQ LA LB LC LD LE LF LG LH LI LJ Palliative Care - 3 submissions exceeded (same drug & same/different pharmacies) & recommended quantity exceeded & non-formulary maximum allowable unit drug cost exceeded Alternative Reimbursement not allowed Alternative Reimbursement Fee exceeds maximum allowable Alternative Reimbursement Type (Quantity) invalid Benefit & non-benefit Rxs - possible duplicate (same pharmacy/same Benefit & non-benefit Rxs - possible duplicate (same pharmacy/different Benefit & non-benefit Rxs - possible duplicate & recommended quantity exceeded & non-formulary maximum allowable unit drug cost exceeded Benefit & non-benefit Rxs - possible duplicate & recommended quantity exceeded Benefit & non-benefit Rxs - possible duplicate & non-formulary maximum allowable unit drug cost exceeded Benefit & non-benefit Rxs - possible duplicate (different pharmacy/same Benefit & non-benefit Rxs - possible duplicate (different pharmacy/different Non-benefit Rxs - possible duplicate (same pharmacy/same Non-benefit Rxs - possible duplicate (same pharmacy/different Non-benefit Rxs - possible duplicate for First Nations/Inuit beneficiary not covered by the Drug Plan Non-benefit Rxs - possible duplicate for HSN without current valid coverage Non-benefit Rxs - possible duplicate for non-benefit DIN Non-benefit Rxs - possible duplicate & 3 submissions exceeded (same drug/same Non-benefit Rxs - possible duplicate & 3 submissions exceeded (same drug/different pharmacies) Non-benefit Rxs - possible duplicate & possible benefit under Exception Drug Status Non-benefit Rxs - possible duplicate & maximum allowable quantity exceeded Non-benefit Rxs - possible duplicate & authorized quantity limit exceeded 280

4 LP LQ Non-benefit Rxs - possible duplicate (different pharmacy/same Non-benefit Rxs - possible duplicate (different pharmacy/different MA Drug mark-up percentage exceeds maximum allowable MB Discount percentage exceeds 100% MS Prescriber ineligible for DIN claimed NA Transmission error - resend PA Online EDS adjudication (OEA) successful PB Online EDS adjudication (OEA) not successful PD Duplicate PACT Fee (same PE Duplicate PACT Fee (different PF Duplicate Prescriptive Authority Fee PG Prescriptive Authority Fee Not Allowed RC Void - original claim not found RD Void - original claim previously voided RE Void not allowed - claim paid to family RG Drug not eligible for Refusal to Dispense Fee Alternative Reimbursement RH Duplicate Refusal to Dispense Fee (same RI Duplicate Refusal to Dispense Fee (different RN Void not allowed - original claim has been adjusted SA Not authorized for automated interface to pharmacy PC - contact Drug Plan Help Desk SB SC SD SF TB TC TD TE TF Drug not eligible for Seamless Care Fee Alternative Reimbursement Duplicate Seamless Care Fee (same Duplicate Seamless Care Fee (different File error - contact Drug Plan Help Desk Drug not eligible for Trial Prescription Program Trial not allowed - not a new medication (previous Rx submitted from same Trial not allowed - not a new medication (previous Rx submitted from different Duplicate trial prescription (same Duplicate trial prescription (different 281

5 TG TH TJ TK TL TM TN TP TQ YI YK YL YM Remainder not allowed - no trial within last 14 days Remainder-duplicate prescription (same Remainder not allowed - dispensed too soon after trial prescription Remainder not allowed - regular Rx submitted within last 14 days (same Remainder not allowed - regular Rx submitted within last 14 days (different Remainder - dispensing fee not allowed - the 2nd fee should be billed as an Alternative Reimbursement Regular Rx not allowed - trial submitted within last 14 days (same Alternative Reimbursement not allowed - no trial within last 30 days Alternative Reimbursement - duplicate submitted within last 30 days (same Maximum allowable quantity exceeded Recommended quantity exceeded Authorized quantity limit exceeded Quantity submitted is lower than the minimum billing quantity for this drug (check 100 day & Two Month Drug Lists) 282

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