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)

 

CG_Manufacturer_Dispute_Reasons_031312_2 (XLS, 26.62Kb)

Last Updated: 03/14/2012