Dispute Edit Codes

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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