Error
Code |
Explanation |
| Ø1 |
M/I Bin |
| Ø2 |
M/I Version Number |
| Ø3 |
M/I Transaction Code |
| Ø4 |
M/I Processor Control Number |
| Ø5 |
M/I Pharmacy Number |
| Ø6 |
M/I Group Number |
| Ø7 |
M/I Cardholder ID Number |
| Ø8 |
M/I Person Code |
| Ø9 |
M/I Birth Date |
| 1C |
M/I Smoker/Non-Smoker Code |
| 1E |
M/I Prescriber Location Code |
| 1Ø |
M/I Patient Gender Code |
| 11 |
M/I Patient Relationship Code |
| 12 |
M/I Patient Location |
| 13 |
M/I Other Coverage Code |
| 14 |
M/I Eligibility Clarification Code |
| 15 |
M/I Date of Service |
| 16 |
M/I Prescription/Service Reference Number |
| 17 |
M/I Fill Number |
| 19 |
M/I Days Supply |
| 2C |
M/I Pregnancy Indicator |
| 2E |
M/I Primary Care Provider ID Qualifier |
| 2Ø |
M/I Compound Code |
| 21 |
M/I Product/Service ID |
| 22 |
M/I Dispense As Written (DAW)/Product Selection Code |
| 23 |
M/I Ingredient Cost Submitted |
| 25 |
M/I Prescriber ID |
| 26 |
M/I Unit Of Measure |
| 28 |
M/I Date Prescription Written |
| 29 |
M/I Number Refills Authorized |
| 3A |
M/I Request Type |
| 3B |
M/I Request Period Date-Begin |
| 3C |
M/I Request Period Date-End |
| 3D |
M/I Basis Of Request |
| 3E |
M/I Authorized Representative First Name |
| 3F |
M/I Authorized Representative Last Name |
| 3G |
M/I Authorized Representative Street Address |
| 3H |
M/I Authorized Representative City Address |
| 3J |
M/I Authorized Representative State/Province Address |
| 3K |
M/I Authorized Representative Zip/Postal Zone |
| 3M |
M/I Prescriber Phone Number |
| 3N |
M/I Prior Authorized Number Assigned |
| 3P |
M/I Authorization Number |
| 3R |
Prior Authorization Not Required |
| 3S |
M/I Prior Authorization Supporting Documentation |
| 3T |
Active Prior Authorization Exists Resubmit At Expiration Of Prior Authorization |
| 3W |
Prior Authorization In Process |
| 3X |
Authorization Number Not Found |
| 3Y |
Prior Authorization Denied |
| 32 |
M/I Level Of Service |
| 33 |
M/I Prescription Origin Code |
| 34 |
M/I Submission Clarification Code |
| 35 |
M/I Primary Care Provider ID |
| 38 |
M/I Basis Of Cost |
| 39 |
M/I Diagnosis Code |
| 4C |
M/I Coordination Of Benefits/Other Payments Count |
| 4E |
M/I Primary Care Provider Last Name |
| 4Ø |
Pharmacy Not Contracted With Plan On Date Of Service |
| 41 |
Submit Bill To Other Processor Or Primary Payer |
| 5C |
M/I Other Payer Coverage Type |
| 5E |
M/I Other Payer Reject Count |
| 5Ø |
Non-Matched Pharmacy Number |
| 51 |
Non-Matched Group ID |
| 52 |
Non-Matched Cardholder ID |
| 53 |
Non-Matched Person Code |
| 54 |
Non-Matched Product/Service ID Number |
| 55 |
Non-Matched Product Package Size |
| 56 |
Non-Matched Prescriber ID |
| 58 |
Non-Matched Primary Prescriber |
| 6C |
M/I Other Payer ID Qualifier |
| 6E |
M/I Other Payer Reject Code |
| 6Ø |
Product/Service Not Covered For Patient Age |
| 61 |
Product/Service Not Covered For Patient Gender |
| 62 |
Patient/Card Holder ID Name Mismatch |
| 63 |
Institutionalized Patient Product/Service ID Not Covered |
| 64 |
Claim Submitted Does Not Match Prior Authorization |
| 65 |
Patient Is Not Covered |
| 66 |
Patient Age Exceeds Maximum Age |
| 67 |
Filled Before Coverage Effective |
| 68 |
Filled After Coverage Expired |
| 69 |
Filled After Coverage Terminated |
| 7C |
M/I Other Payer ID |
| 7E |
M/I DUR/PPS Code Counter |
| 7Ø |
Product/Service Not Covered |
| 71 |
Prescriber Is Not Covered |
| 72 |
Primary Prescriber Is Not Covered |
| 73 |
Refills Are Not Covered |
| 74 |
Other Carrier Payment Meets Or Exceeds Payable |
| 75 |
Prior Authorization Required |
| 76 |
Plan Limitations Exceeded |
| 77 |
Discontinued Product/Service ID Number |
| 78 |
Cost Exceeds Maximum |
| 79 |
Refill Too Soon |
| 8C |
M/I Facility ID |
| 8E |
M/I DUR/PPS Level Of Effort |
| 8Ø |
Drug-Diagnosis Mismatch |
| 81 |
Claim Too Old |
| 82 |
Claim Is Post-Dated |
| 83 |
Duplicate Paid/Captured Claim |
| 84 |
Claim Has Not Been Paid/Captured |
| 85 |
Claim Not Processed |
| 86 |
Submit Manual Reversal |
| 87 |
Reversal Not Processed |
| 88 |
DUR Reject Error |
| 89 |
Rejected Claim Fees Paid |
| 9Ø |
Host Hung Up Host Disconnected Before Session Completed |
| 91 |
Host Response Error Response Not In Appropriate Format To Be Displayed |
| 92 |
System Unavailable/Host Unavailable Processing Host Did Not Accept
Transaction/Did Not Respond Within Time Out Period |
| *95 |
Time Out |
| *96 |
Scheduled Downtime |
| *97 |
Payer Unavailable |
| *98 |
Connection To Payer Is Down |
| 99 |
Host Processing Error Do Not Retransmit Claims |
