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 |