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:
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Codes with a number below 100 represent errors found in the file header.
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Codes in the 100’s and 700’s represent errors found with the data in the detail record.
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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 |
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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 |
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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 - |
Reject |
E240 |
D04 |
ADDITIONAL INFORMATION |
For dispute reason code D04 - |
Reject |
E250 |
D05 |
ADDITIONAL INFORMATION |
For dispute reason code D05 - |
Reject |
E260 |
D06 |
ADDITIONAL INFORMATION |
For dispute reason code D06 - |
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 - 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 - 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 - |
Reject |
E281 |
D08 |
ADDITIONAL INFORMATION |
For dispute reason code D08 - |
Reject |
E290 |
D09 |
DISPUTE REASON CODE / SUPPORTING DATE 1 |
For dispute reason code D09 - |
Reject |
E291 |
D09 |
DISPUTE REASON CODE / SUPPORTING DATE 1/DOS |
For dispute reason code D09 - 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 - |
Reject |
E340 |
D14 |
ADDITIONAL INFORMATION |
For dispute reason code D14 - |
Reject |
E900 |
D99 |
ADDITIONAL INFORMATION |
For dispute reason code D99 - |
Reject |