Discrepancy Type Legend Clause Samples

Discrepancy Type Legend. CF Prescription Not on File — There was no hard copy prescription on file at the pharmacy which corresponded to the claim billed. NRR The pharmacy had no record of a refill being dispensed on the date billed. CQ/R The quantity dispensed by the pharmacy was reduced from the amount authorized by the prescriber and allowed under the applicable Medco Health Plan. OD Overqualified Dispensing — The prescription as written by the prescriber allowed for generic substitution, however, the pharmacy dispensed and billed for the brand-name medication. DG Dispensed Generic, Billed Brand — The pharmacy dispensed the generic medication to the patient while billing for the more expensive brand- name product. UR Unauthorized Refill — The pharmacy exceeded the prescriber’s refill authorization. OBQ Over-billed Quantity — The pharmacy submitted the claim with a metric quantity in excess of the quantity actually dispensed. XDB Incorrect Drug Billed — The medication billed by the pharmacy differs entirely from the medication identified on the prescriber’s prescription order. EPL Exceeds Plan Limits — The quantity of medication dispensed by the pharmacy exceeded the amount allowed under the applicable Medco Health plan. DISP > RX The quantity dispensed exceeded the amount authorized by the prescriber. No Sig Log On File There was no signature log on file at the pharmacy corresponding to the claim billed. Pack Size The pharmacy submitted the claim with the NDC of a smaller package size than should have been dispensed. Comp RX Overpriced compounded prescription. Mail RX The prescription was not personally picked up, nor received through a local delivery service. This definition encompasses mail and other remote delivery carriers. Claim was not authorized as a mail service prescription. MD Not ID Based on the information provided by the pharmacy the prescriber could not be identified. Patient Contests The patient contests receiving the prescription claim reimbursed Receipt under his Member ID number. Prescriber Contests The prescriber contests authorizing the prescription. PND Patient name different — The last name of the patient identified on the prescription differs from the name under which the claim was billed. Return to Stock The claim in question was not picked up by the patient and returned to the pharmacy’s stock. Refill > Than 1 Year The pharmacy dispensed a refill more than one year from the date that the particular prescription was originally written.
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Related to Discrepancy Type Legend

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