Reject Codes
This medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit. Includes Step Therapy and New to Market.
What is a 75 rejection?
The 3 pieces (ID, Name, DOB) of information to verify the member.
What is Member's HIPAA?
The status to review fax request.
What is Incomplete?
Used for virtual meetings and training.
What is Microsoft Teams?
BE
What is Benefit Exclusion?
Non-Formulary medication that providers can request for an exception.
What is a 70/MR rejection?
Running a test claim using the same medication, same date, same quantity, and same pharmacy using the T action.
What is a Quick Test Claim?
The status of an EPA case.
What is Tech Review?
The email sent out at the beginning of the day with Tid Bits and Turn Around Times.
What is the Morning Message email?
MDO
What is Medical Doctor Office?
This medication has quantity and dosage limits that are recommended by the Food and Drug Administration (FDA). The quantity exceeds these limits.
What is a 76 rejection?
Used to search a medication's NDC and package size.
What is Drug Search?
The action button that will move the case into the next status.
What is the Submit button?
Used to search the medication formulary coverage.
What is Medication Look Up?
TID PO
What is 3 times daily by mouth?
Refill too soon
What is a 79 rejection?
This can identify if a member has a BCBS formulary or Standard Control formulary.
What is the Carrier ID?
The action button that will take you back to the Home page. Case will be unassigned from you.
What is the Return button?
The phone AUX status when you're working on faxes/EPAs.
What is the Project (Approved by Leader) status?
EA, ML, GM
What is Each, Milliliters, Grams?
A non-contracted pharmacy is dispensing a specialty medication.
What is a R6 rejection?
Member's formulary when their Carrier ID is NOT 22MC, 22MG, 22ND, 22MY, 22MZ
What is the BCBS Formulary?
This status is when you will release the assignment of the case if you have completed the case (approval, admin deny, No PA).
What is the Pending Correspondence status?
The two phone systems you log into every day.
What is Cisco Jabber & Cisco Finesse?
1 PRN HS
What is 1 as needed at bed time?