NCPDP 5.1 ERROR CODES
Error Code |
Explanation |
AA | Patient Spenddown Not Met |
AB | Date Written Is After Date Filled |
AC | Product Not Covered Non-Participating Manufacturer |
AD | Billing Provider Not Eligible To Bill This Claim Type |
AE | QMB (Qualified Medicare Beneficiary)-Bill Medicare |
AF | Patient Enrolled Under Managed Care |
AG | Days Supply Limitation For Product/Service |
AH | Unit Dose Packaging Only Payable For Nursing Home Recipients |
AJ | Generic Drug Required |
AK | M/I Software Vendor/Certification ID |
AM | M/I Segment Identification |
A9 | M/I Transaction Count |
BE | M/I Professional Service Fee Submitted |
B2 | M/I Service Provider ID Qualifier |
CA | M/I Patient First Name |
CB | M/I Patient Last Name |
CC | M/I Cardholder First Name |
CD | M/I Cardholder Last Name |
CE | M/I Home Plan |
CF | M/I Employer Name |
CG | M/I Employer Street Address |
CH | M/I Employer City Address |
CI | M/I Employer State/Province Address |
CJ | M/I Employer Zip Postal Zone |
CK | M/I Employer Phone Number |
CL | M/I Employer Contact Name |
CM | M/I Patient Street Address |
CN | M/I Patient City Address |
CO | M/I Patient State/Province Address |
CP | M/I Patient Zip/Postal Zone |
CQ | M/I Patient Phone Number |
CR | M/I Carrier ID |
CW | M/I Alternate ID |
CX | M/I Patient ID Qualifier |
CY | M/I Patient ID |
CZ | M/I Employer ID |
DC | M/I Dispensing Fee Submitted |
DN | M/I Basis Of Cost Determination |
DQ | M/I Usual And Customary Charge |
DR | M/I Prescriber Last Name |
DT | M/I Unit Dose Indicator |
DU | M/I Gross Amount Due |
DV | M/I Other Payer Amount Paid |
DX | M/I Patient Paid Amount Submitted |
DY | M/I Date Of Injury |
DZ | M/I Claim/Reference ID |
EA | M/I Originally Prescribed Product/Service Code |
EB | M/I Originally Prescribed Quantity |
EC | M/I Compound Ingredient Component Count |
ED | M/I Compound Ingredient Quantity |
EE | M/I Compound Ingredient Drug Cost |
EF | M/I Compound Dosage Form Description Code |
EG | M/I Compound Dispensing Unit Form Indicator |
EH | M/I Compound Route Of Administration |
EJ | M/I Originally Prescribed Product/Service ID Qualifier |
EK | M/I Scheduled Prescription ID Number |
EM | M/I Prescription/Service Reference Number Qualifier |
EN | M/I Associated Prescription/Service Reference Number |
EP | M/I Associated Prescription/Service Date |
ER | M/I Procedure Modifier Code |
ET | M/I Quantity Prescribed |
EU | M/I Prior Authorization Type Code |
EV | M/I Prior Authorization Number Submitted |
EW | M/I Intermediary Authorization Type ID |
EX | M/I Intermediary Authorization ID |
EY | M/I Provider ID Qualifier |
EZ | M/I Prescriber ID Qualifier |
E1 | M/I Product/Service ID Qualifier |
E3 | M/I Incentive Amount Submitted |
E4 | M/I Reason For Service Code |
E5 | M/I Professional Service Code |
E6 | M/I Result Of Service Code |
E7 | M/I Quantity Dispensed |
E8 | M/I Other Payer Date |
E9 | M/I Provider ID |
FO | M/I Plan ID |
GE | M/I Percentage Sales Tax Amount Submitted |
HA | M/I Flat Sales Tax Amount Submitted |
HB | M/I Other Payer Amount Paid Count |
HC | M/I Other Payer Amount Paid Qualifier |
HD | M/I Dispensing Status |
HE | M/I Percentage Sales Tax Rate Submitted |
HF | M/I Quantity Intended To Be Dispensed |
HG | M/I Days Supply Intended To Be Dispensed |
H1 | M/I Measurement Time |
H2 | M/I Measurement Dimension |
H3 | M/I Measurement Unit |
H4 | M/I Measurement Value |
H5 | M/I Primary Care Provider Location Code |
H6 | M/I DUR Co-Agent ID |
H7 | M/I Other Amount Claimed Submitted Count |
H8 | M/I Other Amount Claimed Submitted Qualifier |
H9 | M/I Other Amount Claimed Submitted |
JE | M/I Percentage Sales Tax Basis Submitted |
J9 | M/I DUR Co-Agent ID Qualifier |
KE | M/I Coupon Type |
M1 | Patient Not Covered In This Aid Category |
M2 | Recipient Locked In |
M3 | Host PA/MC Error |
M4 | Prescription/Service Reference Number/Time Limit Exceeded |
M5 | Requires Manual Claim |
M6 | Host Eligibility Error |
M7 | Host Drug File Error |
M8 | Host Provider File Error |
ME | M/I Coupon Number |
MZ | Error Overflow |
NE | M/I Coupon Value Amount |
NN | Transaction Rejected At Switch Or Intermediary |
PA | PA Exhausted/Not Renewable |
PB | Invalid Transaction Count For This Transaction Code |
PC | M/I Claim Segment |
PD | M/I Clinical Segment |
PE | M/I COB/Other Payments Segment |
PF | M/I Compound Segment |
PG | M/I Coupon Segment |
PH | M/I DUR/PPS Segment |
PJ | M/I Insurance Segment |
PK | M/I Patient Segment |
PM | M/I Pharmacy Provider Segment |
PN | M/I Prescriber Segment |
PP | M/I Pricing Segment |
PR | M/I Prior Authorization Segment |
PS | M/I Transaction Header Segment |
PT | M/I Workers’ Compensation Segment |
PV | Non-Matched Associated Prescription/Service Date |
PW | Non-Matched Employer ID |
PX | Non-Matched Other Payer ID |
PY | Non-Matched Unit Form/Route of Administration |
PZ | Non-Matched Unit Of Measure To Product/Service ID |
P1 | Associated Prescription/Service Reference Number Not Found |
P2 | Clinical Information Counter Out Of Sequence |
P3 | Compound Ingredient Component Count Does Not Match Number Of Repetitions |
P4 | Coordination Of Benefits/Other Payments Count Does Not Match Number Of Repetitions |
P5 | Coupon Expired |
P6 | Date Of Service Prior To Date Of Birth |
P7 | Diagnosis Code Count Does Not Match Number Of Repetitions |
P8 | DUR/PPS Code Counter Out Of Sequence |
P9 | Field Is Non-Repeatable |
RA | PA Reversal Out Of Order |
RB | Multiple Partials Not Allowed |
RC | Different Drug Entity Between Partial & Completion |
RD | Mismatched Cardholder/Group ID-Partial To Completion |
RE | M/I Compound Product ID Qualifier |
RF | Improper Order Of ‘Dispensing Status’ Code On Partial Fill Transaction |
RG | M/I Associated Prescription/service Reference Number On Completion Transaction |
RH | M/I Associated Prescription/Service Date On Completion Transaction |
RJ | Associated Partial Fill Transaction Not On File |
RK | Partial Fill Transaction Not Supported |
RM | Completion Transaction Not Permitted With Same‘Date Of Service’ As Partial Transaction |
RN | Plan Limits Exceeded On Intended Partial Fill Values |
RP | Out Of Sequence ‘P’ Reversal On Partial Fill Transaction |
RS | M/I Associated Prescription/Service Date On Partial Transaction |
RT | M/I Associated Prescription/Service Reference Number On Partial Transaction |
RU | Mandatory Data Elements Must Occur Before Optional Data Elements In A Segment |
R1 | Other Amount Claimed Submitted Count Does Not Match Number Of Repetitions |
R2 | Other Payer Reject Count Does Not Match Number Of Repetitions |
R3 | Procedure Modifier Code Count Does Not Match Number Of Repetitions |
R4 | Procedure Modifier Code Invalid For Product/Service ID |
R5 | Product/Service ID Must Be Zero When Product/Service ID Qualifier Equals |
R6 | Product/Service Not Appropriate For This Location |
R7 | Repeating Segment Not Allowed In Same Transaction |
R8 | Syntax Error |
R9 | Value In Gross Amount Due Does Not Follow Pricing Formulae |
SE | M/I Procedure Modifier Code Count |
TE | M/I Compound Product ID |
UE | M/I Compound Ingredient Basis Of Cost Determination |
VE | M/I Diagnosis Code Count |
WE | M/I Diagnosis Code Qualifier |
XE | M/I Clinical Information Counter |
ZE | M/I Measurement Date |