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
P4 Coordination Of Benefits/Other Payments Count Does Not Match Number Of
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
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
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
R1 Other Amount Claimed Submitted Count Does Not Match Number Of
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