Reject Code Numbers
Which code is “Refill Too Soon”?
79
What does code 88 mean?
DUR (Drug Utilization Review)
How do you resolve code 79?
Transfer
A prescription cannot be filled because of a conflict with another medication. which code is it?
88
Which code is “Step Therapy”?
608
Which reject means the medication must be filled at a specialty pharmacy?
4W
How do you resolve code 608?
Provide alternative drug that can be taken, if given push back initiate PA
A member’s drug costs more than the threshold dollar limit. Which reject code is this?
78
Which code is “Claim on hold at PMart – awaiting SCC funding”?
8x
What does code 7X mean?
Day Supply Exceeds Plan Limitation
How do you resolve code 4W?
Advise the caller of the pharmacy that the medication needs to be filled at
A prescription is stuck because funding approval is still pending.
8x