Dispute Reasons
| DISPUTE REASON CODE |
DISPUTE REASON DESCRIPTION |
SUPPORTING DETAIL REFERENCE NUMBER |
SUPPORTING DATE 1 |
SUPPORTING DATE 2 |
ADDITIONAL INFORMATION |
|---|---|---|---|---|---|
| D01 | Duplicate Invoice Item | Reference Number | Provide additional supporting evidence (optional) | ||
| D02 | Closed Pharmacy | NCPDP closed date | Provide additional supporting evidence (optional) | ||
| D03 | Not PART D Covered Drug | Explain statutory exclusion that applies to this drug (required) | |||
| D04 | Excessive Quantity | Excessive quantity on individual invoice item. Provide proprietary benchmark used to identify excessive quantity (required) | |||
| D05 | Invalid Days Supply | Provide additional supporting information (required) | |||
| D06 | High Price of the Drug | Provide additional supporting information (required) | |||
| D07 | Last Lot Expiration Date | NDC directory drop date | Last lot expiration date | Provide additional supporting information (required) | |
| D08 | Early Fill | Reference Number for early fill disputed | Provide additional supporting information (required) | ||
| D09 | Marketing Category is not NDA or BLA | FDA update date | Provide additional supporting information (required) | ||
| D10 | Date of Service prior to 01/01/2011 | Provide additional supporting information (required) | |||
| D11 | PDE improperly invoiced beyond Manufacturer Agreement Invoice period | Provide additional supporting information (required) | |||
| D12 | Invalid Prescription Service Reference Number | Provide additional supporting information (required) | |||
| D13 | Gap discount for disputed PDE exceeds maximum discount amount for a single PDE | Provide additional supporting information (required) | |||
| D14 | Total accumulated gap discounts reported across multiple PDEs for a single beneficiary exceed cumulative maximum discount amount | Provide additional supporting information (required) | |||
| D99 | Other | Provide additional supporting information (required) |
Last Updated: 03/14/2012