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Model N Helpcenter

Dispute Edit Codes

The following table provides a description of the dispute error codes that can be added to a Coverage Gap data line when reading a TPA dispute return file. The codes have different numbers based where the error was found in the dispute submission file:

  • Codes with a number below 100 represent errors found in the file header.

  • Codes in the 100’s and 700’s represent errors found with the data in the detail record.

  • Codes in the 200’s, 300's, and 900’s represent errors specific to the dispute codes provided in the dispute submission file.

For information on the dispute edit codes, click this link: http://tpadministrator.com.

Dispute Edit Code

Edit Category

Data Element to be Edited

Message to be Reported

Failure Outcome (Reject)

Editing Manufacturer Dispute Fields

E001

INVALID

REPORT ID

Invalid Report Id

Reject

E002

MISSING-INVALID

REPORT ID

Report Id in TPAMT record does not match the TPAMH

Reject

E004

MISSING-INVALID

FILE ID

Invalid File Id

Reject

E005

MISSING-INVALID

MANUFACTURER P NUMBER

Invalid "P" number

Reject

E006

INVALID

TPA DISPUTE RECEIVED DATE 

Dispute date precedes data report distribution date

Reject

E007

MISSING-INVALID

INVOICE DELIVERED DATE, TPA DISPUTE RECEIVED DATE 

No date entered/invalid, or date is > current date

Reject

E010

INVALID

RECORD TYPE CODE

Invalid record types in file.

Reject

E011

MISSING

RECORD TYPE CODE

Missing record types in file

Reject

E014

INVALID

TPA DISPUTE RECEIVED DATE 

Dispute received after the 60 day deadline

Reject

E017

MISSING-INVALID

REPORT ID, FILE ID, PNUMBER, PROCESS DATE 

Duplicate dispute report already accepted. 

Reject

E101

MISSING-INVALID

REPORT ID / DETAIL REF NUMBER

Disputed detail reference number cannot be found on the manufacturer invoice specified.

Reject

E102

MISSING-INVALID

REPORT ID  / DETAIL REF NUMBER

Detail reference number is not valid.

Reject

E103

MISSING-INVALID

TPA DISPUTE RECEIVED DATE / INVOICE DELIVERED DATE 

Dispute received > 60 calendar days after invoice delivered date.

Note: Disputes will not be accepted by CMS after 60 days, The count of the day starts when CMS delivered the invoices to manufacturers.

Reject

E104

MISSING-INVALID

PREVIOUS REPORT ID

Previous report identifier cannot be altered from original invoiced previous report identifier.

Reject

E105

MISSING-INVALID

PRODUCT SERVICE ID

Product service identifier cannot be altered from original invoiced product service identifier.

Reject

E106

MISSING-INVALID

PRESCRIPTION SERVICE REFERENCE NO

Prescription service reference number cannot be altered from original invoiced prescription service reference number.

Reject

E107

MISSING-INVALID

FILL NUMBER

Fill number cannot be altered from original invoiced fill number.

Reject

E108

MISSING-INVALID

DAYS SUPPLY

Days supply cannot be altered from original invoiced days supply.

Reject

E109

MISSING-INVALID

QUANTITY DISPENSED

Quantity dispensed cannot be altered from original invoiced quantity dispensed.

Reject

E110

MISSING-INVALID

DATE OF SERVICE (DOS)

Date of service cannot be altered from original invoiced date of service.

Reject

E111

MISSING-INVALID

SERVICE PROVIDER ID QUALIFIER

Service provider identifier qualifier cannot be altered from original invoiced Service provider identifier qualifier

Reject

E112

MISSING-INVALID

SERVICE PROVIDER ID

Service provider identifier cannot be altered from original invoiced Service provider identifier

Reject

E113

MISSING-INVALID

REPORTED GAP DISCOUNT PREVIOUS AMOUNT

Reported gap discount previous amount cannot be altered from original invoiced Reported gap discount previous amount

Reject

E114

MISSING-INVALID

REPORTED GAP DISCOUNT CURRENT AMOUNT

Reported gap discount current amount  cannot be altered from original invoiced Reported gap discount current amount 

Reject

E115

MISSING-INVALID

GAP DISCOUNT AMOUNT THIS PERIOD

Gap discount amount this period cannot be altered from original invoiced date of service

Reject

E116

MISSING-INVALID

PRIOR LOW VOLUME DISCOUNT FLAG

Prior low volume discount flag cannot be altered from original invoiced prior low volume discount flag

Reject

E117

MISSING-INVALID

DISPUTE REASON CODE

Invalid dispute reason code.

Reject

E118

MISSING-INVALID

P-NUMBER/SUPPORTING DETAIL REFERENCE NUMBER

Supporting detail reference number does not exist on any  manufacturer Invoice .

Reject

E119

MISSING-INVALID

SUPPORTING DATE 1

Invalid calendar date

Reject

E120

MISSING-INVALID

SUPPORTING DATE 2

Invalid calendar date

Reject

E121

MISSING-INVALID

FILLER

Filler must be spaces.

Reject

E122

MISSING-INVALID

PREVIOUS REPORTING PERIOD

Previous reporting period cannot be altered from original invoiced Current reporting period

Reject

E123

MISSING-INVALID

CURRENT REPORTING PERIOD

Current reporting period cannot be altered from original invoiced Previous reporting period

Reject

E126

MISSING-INVALID

DISPUTE REASON CODE

Dispute reason code is no longer valid.

Reject

E777

DUPLICATE

REPORT ID / DETAIL REF NUMBER

Duplicate dispute. Original dispute has already been accepted for dispute consideration.

Reject

E785

DUPLICATE

REPORT ID / DETAIL REF NUMBER

Duplicate dispute exists within the submitted file. All duplicated records within this file are rejected.

Note: Reject both the disputes, if it is an duplicate.

Reject

Editing Based on Dispute Reason Code

E210

D01

DISPUTE REASON CODE / SUPPORTING DETAIL REFERENCE NUMBER

For dispute reason code D01 -  Supporting Detail Reference Number is missing. The Detail Reference Number of the duplicate claim is required.

Reject

E220

D02

DISPUTE REASON CODE / SUPPORTING DATE 1

For dispute reason code D02 -  Supporting Date 1 is missing. The NCPDP Pharmacy Closed Date should be reported in Supported Date 1.

Reject

E221

D02

DISPUTE REASON CODE / SUPPORTING DATE 1/DOS

For dispute reason code D02 -  Supporting Date 1 (NCPDP pharmacy Closed Date) is after PDE DOS.

Note: For Dispute reason code D02 (closed pharmacy) - Supporting date 1 (NCPDP pharmacy closed date) should be before PDE DOS.

Reject

E230

D03

ADDITIONAL INFORMATION

For dispute reason code D03 - 
Additional Information field is blank. Additional Information is required.

Reject

E240

D04

ADDITIONAL INFORMATION

For dispute reason code D04 - 
Additional Information field is blank. Additional Information is required.

Reject

E250

D05

ADDITIONAL INFORMATION

For dispute reason code D05 - 
Additional Information field is blank. Additional Information is required.

Reject

E260

D06

ADDITIONAL INFORMATION

For dispute reason code D06 - 
Additional Information field is blank. Additional Information is required.

Reject

E270

D07

DISPUTE REASON CODE / SUPPORTING DATE 1 

For dispute reason code D07 -  Supporting Date 1 is missing. The NDC Directory Drop Date is required.

Reject

E271

D07

DISPUTE REASON CODE /SUPPORTING DATE 2

For dispute reason code D07 -  Supporting Date 2 is missing. The Last Lot Expiration Date is required.

Reject

E272

D07

DISPUTE REASON CODE / SUPPORTING DATE 1 / DOS

For dispute reason code D07 -
Supporting Date 1 (FDA NDC Directory Drop Date) is after the PDE Date of Service.

Note: For Dispute reason code D07 (last lot expiration date) - Supporting date 1 (FDA NDC Directory drop date) should be before PDE DOS.

Reject

E273

D07

DISPUTE REASON CODE / SUPPORTING DATE 2 / DOS

For dispute reason code D07 -
Supporting Date 2 (Last Lot Expiration Date) is after the PDE Date of Service.

Note: For Dispute reason code D07 (last lot expiration date) - Supporting Date 2 (Last Lot Expiration Date) should be before PDE DOS.

Reject

E280

D08

DISPUTE REASON CODE / SUPPORTING DETAIL REFERENCE NUMBER

For dispute reason code D08 -
Supporting Detail Reference Number is missing. The Detail Reference Number of the previous fill is required.

Reject

E281

D08

ADDITIONAL INFORMATION

For dispute reason code D08 - 
Additional Information field is blank. Additional Information is required.

Reject

E290

D09

DISPUTE REASON CODE / SUPPORTING DATE 1

For dispute reason code D09 -
Supporting Date 1 is missing. The FDA NDC Directory Update Date is required to document the NDC is not an NDA or BLA.

Reject

E291

D09

DISPUTE REASON CODE / SUPPORTING DATE 1/DOS

For dispute reason code D09 -
Supporting Date 1 (FDA NDC Directory update date) is after PDE DOS.

Note: For Dispute reason code D09 (Marketing category is not NDA or BLA) - Supporting date 1 (FDA NDC Directory update date) should be before PDE DOS.

Reject

E330

D13

ADDITIONAL INFORMATION

For dispute reason code D13 -
Additional Information field is blank.
Additional Information is required.

Reject

E340

D14

ADDITIONAL INFORMATION

For dispute reason code D14 -
Additional Information field is blank.
Additional Information is required.

Reject

E900

D99

ADDITIONAL INFORMATION

For dispute reason code D99 - 
Additional Information field is blank. Additional Information is required.

Reject

 

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