Medi-Cal: National Council of Prescription Drugs Program (NCPDP) Reject Codes

National Council of Prescription Drugs Program (NCPDP) Reject Codes

Note: not all codes are returned by Medi-Cal.

Reject Code	Reject Description
1	Missing or Invalid BIN
2	Missing or Invalid Version Number
3	Missing or Invalid Transaction Code
4	Missing or Invalid Processor Control Number
5	Missing or Invalid Pharmacy Number
6	Missing or Invalid Group Number
7	Missing or Invalid Cardholder ID Number
8	Missing or Invalid Person Code
9	Missing or Invalid Birth Date
10	Missing or Invalid Patient Gender Code
11	Missing or Invalid Patient Relationship Code
12	Missing or Invalid Patient Location
13	Missing or Invalid Other Coverage Code
14	Missing or Invalid Eligibility Clarification Code
15	Missing or Invalid Date of Service
16	Missing or Invalid Prescription/Service Reference Number
17	Missing or Invalid Fill Number
19	Missing or Invalid Days Supply
1C	Missing or Invalid Smoker/Non-Smoker Code
1E	Missing or Invalid Prescriber Location Code
20	Missing or Invalid Compound Code
21	Missing or Invalid Product/Service ID
22	Missing or Invalid Dispense As Written (DAW)/Product Selection Code
23	Missing or Invalid Ingredient Cost Submitted
25	Missing or Invalid Prescriber ID
26	Missing or Invalid Unit of Measure
28	Missing or Invalid Date Prescription Written
29	Missing or Invalid Number Refills Authorized
2C	Missing or Invalid Pregnancy Indicator
2E	Missing or Invalid Primary Care Provider ID Qualifier
32	Missing or Invalid Level Of Service
33	Missing or Invalid Prescription Origin Code
34	Missing or Invalid Submission Clarification Code
35	Missing or Invalid Primary Care Provider ID
38	Missing or Invalid Basis Of Cost
39	Missing or Invalid Diagnosis Code
3A	Missing or Invalid Request Type
3B	Missing or Invalid Request Period Date-Begin
3C	Missing or Invalid Request Period Date-End
3D	Missing or Invalid Basis Of Request=
3E	Missing or Invalid Authorized Representative First Name
3F	Missing or Invalid Authorized Representative Last Name
3G	Missing or Invalid Authorized Representative Street Address
3H	Missing or Invalid Authorized Representative City Address
3J	Missing or Invalid Authorized Representative State/Province Address
3K	Missing or Invalid Authorized Representative Zip/Postal Zone
3M	Missing or Invalid Prescriber Phone Number
3N	Missing or Invalid Prior Authorized Number Assigned
3P	Missing or Invalid Authorization Number
3R	Prior Authorization Not Required
3S	Missing or Invalid 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
40	Pharmacy Not Contracted With Plan On Date Of Service
41	Submit Bill To Other Processor Or Primary Payer
4C	Missing or Invalid Coordination Of Benefits/Other Payments Count
4E	Missing or Invalid Primary Care Provider Last Name
50	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
5C	Missing or Invalid Other Payer Coverage Type
5E	Missing or Invalid Other Payer Reject Count
60	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
6C	Missing or Invalid Other Payer ID Qualifier
6E	Missing or Invalid Other Payer Reject Code
70	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
7C	Missing or Invalid Other Payer ID
7E	Missing or Invalid DUR/PPS Code Counter
80	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
8C	Missing or Invalid Facility ID
8E	Missing or Invalid DUR/PPS Level Of Effort
90	Host Hung Up
91	Host Response Error
92	System Unavailable/Host Unavailable
95	Time Out
96	Scheduled Downtime
97	Payer Unavailable
98	Connection To Payer Is Down
99	Host Processing Error
A9	Missing or Invalid Transaction Count
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	Missing or Invalid Software Vendor/Certification ID
AM	Missing or Invalid Segment Identification
B2	Missing or Invalid Service Provider ID Qualifier
BE	Missing or Invalid Professional Service Fee Submitted
CA	Missing or Invalid Patient First Name
CB	Missing or Invalid Patient Last Name
CC	Missing or Invalid Cardholder First Name
CD	Missing or Invalid Cardholder Last Name
CE	Missing or Invalid Home Plan
CF	Missing or Invalid Employer Name
CG	Missing or Invalid Employer Street Address
CH	Missing or Invalid Employer City Address
CI	Missing or Invalid Employer State/Province Address
CJ	Missing or Invalid Employer Zip Postal Zone
CK	Missing or Invalid Employer Phone Number
CL	Missing or Invalid Employer Contact Name
CM	Missing or Invalid Patient Street Address
CN	Missing or Invalid Patient City Address
CO	Missing or Invalid Patient State/Province Address
CP	Missing or Invalid Patient Zip/Postal Zone
CQ	Missing or Invalid Patient Phone Number
CR	Missing or Invalid Carrier ID
CW	Missing or Invalid Alternate ID
CX	Missing or Invalid Patient ID Qualifier
CY	Missing or Invalid Patient ID
CZ	Missing or Invalid Employer ID
DC	Missing or Invalid Dispensing Fee Submitted
DN	Missing or Invalid Basis Of Cost Determination
DQ	Missing or Invalid Usual And Customary Charge
DR	Missing or Invalid Prescriber Last Name
DT	Missing or Invalid Unit Dose Indicator
DU	Missing or Invalid Gross Amount Due
DV	Missing or Invalid Other Payer Amount Paid
DX	Missing or Invalid Patient Paid Amount Submitted
DY	Missing or Invalid Date Of Injury
DZ	Missing or Invalid Claim/Reference ID
E1	Missing or Invalid Product/Service ID Qualifier
E3	Missing or Invalid Incentive Amount Submitted
E4	Missing or Invalid Reason For Service Code
E5	Missing or Invalid Professional Service Code
E6	Missing or Invalid Result Of Service Code
E7	Missing or Invalid Quantity Dispensed
E8	Missing or Invalid Other Payer Date
E9	Missing or Invalid Provider ID
EA	Missing or Invalid Originally Prescribed Product/Service Code
EB	Missing or Invalid Originally Prescribed Quantity
EC	Missing or Invalid Compound Ingredient Component Count
ED	Missing or Invalid Compound Ingredient Quantity
EE	Missing or Invalid Compound Ingredient Drug Cost
EF	Missing or Invalid Compound Dosage Form Description Code
EG	Missing or Invalid Compound Dispensing Unit Form Indicator
EH	Missing or Invalid Compound Route Of Administration
EJ	Missing or Invalid Originally Prescribed Product/Service ID Qualifier
EK	Missing or Invalid Scheduled Prescription ID Number
EM	Missing or Invalid Prescription/Service Reference Number Qualifier
EN	Missing or Invalid Associated Prescription/Service Reference Number
EP	Missing or Invalid Associated Prescription/Service Date
ER	Missing or Invalid Procedure Modifier Code
ET	Missing or Invalid Quantity Prescribed
EU	Missing or Invalid Prior Authorization Type Code
EV	Missing or Invalid Prior Authorization Number Submitted
EW	Missing or Invalid Intermediary Authorization Type ID
EX	Missing or Invalid Intermediary Authorization ID
EY	Missing or Invalid Provider ID Qualifier
EZ	Missing or Invalid Prescriber ID Qualifier
FO	Missing or Invalid Plan ID
GE	Missing or Invalid Percentage Sales Tax Amount Submitted
H1	Missing or Invalid Measurement Time
H2	Missing or Invalid Measurement Dimension
H3	Missing or Invalid Measurement Unit
H4	Missing or Invalid Measurement Value
H5	Missing or Invalid Primary Care Provider Location Code
H6	Missing or Invalid DUR Co-Agent ID
H7	Missing or Invalid Other Amount Claimed Submitted Count
H8	Missing or Invalid Other Amount Claimed Submitted Qualifier
H9	Missing or Invalid Other Amount Claimed Submitted
HA	Missing or Invalid Flat Sales Tax Amount Submitted
HB	Missing or Invalid Other Payer Amount Paid Count
HC	Missing or Invalid Other Payer Amount Paid Qualifier
HD	Missing or Invalid Dispensing Status
HE	Missing or Invalid Percentage Sales Tax Rate Submitted
HF	Missing or Invalid Quantity Intended To Be Dispensed
HG	Missing or Invalid Days Supply Intended To Be Dispensed
J9	Missing or Invalid DUR Co-Agent ID Qualifier
JE	Missing or Invalid Percentage Sales Tax Basis Submitted
KE	Missing or Invalid 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	Missing or Invalid Coupon Number
MZ	Error Overflow
NE	Missing or Invalid Coupon Value Amount
NN	Transaction Rejected At Switch Or Intermediary
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
PA	PA Exhausted/Not Renewable
PB	Invalid Transaction Count For This Transaction Code
PC	Missing or Invalid Claim Segment
PD	Missing or Invalid Clinical Segment
PE	Missing or Invalid COB/Other Payments Segment
PF	Missing or Invalid Compound Segment
PG	Missing or Invalid Coupon Segment
PH	Missing or Invalid DUR/PPS Segment
PJ	Missing or Invalid Insurance Segment
PK	Missing or Invalid Patient Segment
PM	Missing or Invalid Pharmacy Provider Segment
PN	Missing or Invalid Prescriber Segment
PP	Missing or Invalid Pricing Segment
PR	Missing or Invalid Prior Authorization Segment
PS	Missing or Invalid Transaction Header Segment
PT	Missing or Invalid 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
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 Ø6
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
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	Missing or Invalid Compound Product ID Qualifier
RF	Improper Order Of ‘Dispensing Status’ Code On Partial Fill Transaction
RG	Missing or Invalid Associated Prescription/service Reference Number On Completion Transaction
RH	Missing or Invalid 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	Missing or Invalid Associated Prescription/Service Date On Partial Transaction
RT	Missing or Invalid Associated Prescription/Service Reference Number On Partial Transaction
RU	Mandatory Data Elements Must Occur Before Optional Data Elements In A Segment
SE	Missing or Invalid Procedure Modifier Code Count
TE	Missing or Invalid Compound Product ID
UE	Missing or Invalid Compound Ingredient Basis Of Cost Determination
VE	Missing or Invalid Diagnosis Code Count
WE	Missing or Invalid Diagnosis Code Qualifier
XE	Missing or Invalid Clinical Information Counter
ZE	Missing or Invalid Measurement Date

References

National Council of Prescription Drugs Program (NCPDP) Reject Codes