NCPDP 5.1 ERROR CODES

NCPDP 5.1 ERROR CODES

	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

NCPDP error codes with explanation

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